1013570092 NPI number — ABC HEALTHCARE SERVICES, LLC

Table of content: (NPI 1013570092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013570092 NPI number — ABC HEALTHCARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABC HEALTHCARE SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013570092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13013 INNISBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20705-1195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-468-1078
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13013 INNISBROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20705-1195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-624-6010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MENDPARA
Authorized Official First Name:
BHARAT
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
420-624-6010

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 56600107-00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".