Provider Demographics
NPI:1053837294
Name:HAILU, YOHANNES ABATE
Entity Type:Individual
Prefix:
First Name:YOHANNES
Middle Name:ABATE
Last Name:HAILU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NOAH'S ARC
Other - Middle Name:
Other - Last Name:TRANSPORTATION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:100 SASSAFRAS ST
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-4538
Mailing Address - Country:US
Mailing Address - Phone:512-947-1306
Mailing Address - Fax:214-594-8385
Practice Address - Street 1:100 SASSAFRAS ST
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634
Practice Address - Country:US
Practice Address - Phone:512-947-1306
Practice Address - Fax:214-594-8385
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)