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General NPI Number Information
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NPI Number | 1598270852
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Entity Type | Organization
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Legal Business Name | VENCER CARE, LLC
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 255 W SPRING VALLEY AVE STE 201
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City | MAYWOOD
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State | NJ
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Zip | 07607-1444
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Country | US
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Telephone | 888-554-9554
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Fax | 201-881-0776
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Provider Business Mailing Address
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Address Line | 255 W SPRING VALLEY AVE STE 201
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City | MAYWOOD
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State | NJ
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Zip | 07607-1444
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Country | US
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Telephone | 888-554-9554
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Fax | 201-881-0776
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN BAHRI
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Credential |
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Telephone | 201-881-0773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 28RS00734800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 28RS00734800
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License Number State | NY
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