Provider Demographics
NPI:1942605001
Name:BHANJA ENTERPRISES LLC
Entity Type:Organization
Organization Name:BHANJA ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT
Authorized Official - Prefix:MR
Authorized Official - First Name:PARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHANJA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:440-497-8498
Mailing Address - Street 1:8770 GLASGOW POINTE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8770 GLASGOW POINTE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-6606
Practice Address - Country:US
Practice Address - Phone:440-497-8498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005936225X00000X
GAOT005960225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty