Provider Demographics
NPI:1073688594
Name:AABON HOME HEALTH CARE SUPPLY, INC.
Entity Type:Organization
Organization Name:AABON HOME HEALTH CARE SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:334-774-7535
Mailing Address - Street 1:136 E REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-1530
Mailing Address - Country:US
Mailing Address - Phone:334-774-7535
Mailing Address - Fax:334-445-1736
Practice Address - Street 1:136 E REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-1530
Practice Address - Country:US
Practice Address - Phone:334-774-7535
Practice Address - Fax:334-445-1736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11070332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL56909OtherBLUECROSS BLUESHIELD
AL000054200Medicaid
AL000054200Medicaid