Provider Demographics
NPI:1023854718
Name:NDZE, BINSEKA
Entity type:Individual
Prefix:
First Name:BINSEKA
Middle Name:
Last Name:NDZE
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 1:3514 W SAINT CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-5010
Mailing Address - Country:US
Mailing Address - Phone:480-316-8449
Mailing Address - Fax:
Practice Address - Street 1:3514 W SAINT CHARLES AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5010
Practice Address - Country:US
Practice Address - Phone:480-316-8449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCR-219669-13781385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child