1164428702 NPI number — ABI CARE HOME HEALTH, LLC

Table of content: (NPI 1164428702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164428702 NPI number — ABI CARE HOME HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABI CARE HOME HEALTH, 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:
6
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:
1164428702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2974 LBJ FWY
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75234-7602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-241-2419
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2974 LBJ FWY
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75234-7602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-241-2419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
OSUKOYA
Authorized Official First Name:
OLATUNBOSUN
Authorized Official Middle Name:
OLUSEGUN
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
972-241-2419

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  004704 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 024197801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000HH9268 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com