Provider Demographics
NPI:1073816724
Name:ABIGAIL'S CARE CENTER,LLC
Entity Type:Organization
Organization Name:ABIGAIL'S CARE CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUBE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMODU
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:281-467-9043
Mailing Address - Street 1:7506 CYPRESS BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1725
Mailing Address - Country:US
Mailing Address - Phone:281-467-9043
Mailing Address - Fax:
Practice Address - Street 1:7506 CYPRESS BLUFF DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1725
Practice Address - Country:US
Practice Address - Phone:281-467-9043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities