Provider Demographics
NPI:1104363340
Name:ABIGAIL ELAINE AGENCY LLC
Entity Type:Organization
Organization Name:ABIGAIL ELAINE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINGELSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-956-3231
Mailing Address - Street 1:4786 DRESSLER RD NW
Mailing Address - Street 2:SUITE180
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44712
Mailing Address - Country:US
Mailing Address - Phone:330-956-3231
Mailing Address - Fax:
Practice Address - Street 1:4786 DRESSLER RD NW
Practice Address - Street 2:SUITE180
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44712
Practice Address - Country:US
Practice Address - Phone:330-956-3231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health