Provider Demographics
NPI:1730940479
Name:BAGENDA, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BAGENDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18W140 BUTTERFIELD RD FL 15
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4843
Mailing Address - Country:US
Mailing Address - Phone:630-613-7788
Mailing Address - Fax:630-613-7787
Practice Address - Street 1:18W140 BUTTERFIELD RD FL 15
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4843
Practice Address - Country:US
Practice Address - Phone:630-613-7788
Practice Address - Fax:630-613-7787
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No374U00000XNursing Service Related ProvidersHome Health Aide