Healthcare Provider Details

I. General information

NPI: 1316777543
Provider Name (Legal Business Name): BENDA HEALTH EDUCATION AND TESTING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4680 W BRADLEY RD STE 204A
BROWN DEER WI
53223-3764
US

IV. Provider business mailing address

5533 N 54TH ST
MILWAUKEE WI
53218-3338
US

V. Phone/Fax

Practice location:
  • Phone: 281-836-1869
  • Fax:
Mailing address:
  • Phone: 281-836-1869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code331L00000X
TaxonomyBlood Bank
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BENDU MCBORROUGH DAWOLO
Title or Position: OWNER/CEO
Credential: DHA
Phone: 281-836-1869