Provider Demographics
NPI:1013360619
Name:ABBAS CONSTRUCTION INC
Entity Type:Organization
Organization Name:ABBAS CONSTRUCTION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:P
Authorized Official - Last Name:VILLARRUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-491-0691
Mailing Address - Street 1:3590 JUBILANT PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-2513
Mailing Address - Country:US
Mailing Address - Phone:719-491-0691
Mailing Address - Fax:719-591-2140
Practice Address - Street 1:3590 JUBILANT PL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-2513
Practice Address - Country:US
Practice Address - Phone:719-491-0691
Practice Address - Fax:719-591-2140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABBAS CONSTRUCTION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21547171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58689559Medicaid