Provider Demographics
NPI:1093776031
Name:ABACAW ENTERPRISES INC
Entity Type:Organization
Organization Name:ABACAW ENTERPRISES INC
Other - Org Name:GOLDEN POND HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:469-767-3652
Mailing Address - Street 1:530 NEWCASTLE LN
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4165
Mailing Address - Country:US
Mailing Address - Phone:469-767-3652
Mailing Address - Fax:972-423-7906
Practice Address - Street 1:530 NEWCASTLE LN
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4165
Practice Address - Country:US
Practice Address - Phone:469-767-3652
Practice Address - Fax:972-423-7906
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABACAW ENTERPRISES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-29
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009680251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-9250OtherCMS