Healthcare Provider Details

I. General information

NPI: 1700558756
Provider Name (Legal Business Name): BEND HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 E WASHINGTON AVE FL 2
MADISON WI
53703-4647
US

IV. Provider business mailing address

9450 SW GEMINI DR # 58509
BEAVERTON OR
97008-7105
US

V. Phone/Fax

Practice location:
  • Phone: 800-516-0975
  • Fax: 608-709-8102
Mailing address:
  • Phone: 800-516-0975
  • Fax: 608-709-8102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MONIKA DRUMMOND ROOTS
Title or Position: PRESIDENT
Credential: MD
Phone: 800-516-0975