Healthcare Provider Details

I. General information

NPI: 1598270852
Provider Name (Legal Business Name): VENCER CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W SPRING VALLEY AVE STE 201
MAYWOOD NJ
07607-1444
US

IV. Provider business mailing address

255 W SPRING VALLEY AVE STE 201
MAYWOOD NJ
07607-1444
US

V. Phone/Fax

Practice location:
  • Phone: 888-554-9554
  • Fax: 201-881-0776
Mailing address:
  • Phone: 888-554-9554
  • Fax: 201-881-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number28RS00734800
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number28RS00734800
License Number StateNJ

VIII. Authorized Official

Name: JOHN BAHRI
Title or Position: PRESIDENT
Credential:
Phone: 201-881-0773