MEDICARE: MRS. BENDU BILITY I CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1013510049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BENDU BILITY I CNA

Provider Business Mailing Address
First Line	:	7404 W SOUTHGATE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-2057
Country	:	US
Telephone Number	:	480-228-0896
Fax Number	:

Provider Business Practice Location Address
First Line	:	7404 W SOUTHGATE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-2057
Country	:	US
Telephone Number	:	480-228-0896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	11/20/2020

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