Provider Demographics
NPI:1669003885
Name:HADDBM LLC
Entity Type:Organization
Organization Name:HADDBM LLC
Other - Org Name:MAHADD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIEUDONNE
Authorized Official - Middle Name:CHE
Authorized Official - Last Name:NDENGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-913-8414
Mailing Address - Street 1:1895 COUNTY RD E EAST, SUITE @210
Mailing Address - Street 2:
Mailing Address - City:WHITEBEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4460
Mailing Address - Country:US
Mailing Address - Phone:612-913-8414
Mailing Address - Fax:
Practice Address - Street 1:1895 COUNTY RD E EAST, SUITE @210
Practice Address - Street 2:
Practice Address - City:WHITEBEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110
Practice Address - Country:US
Practice Address - Phone:612-913-8414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health