Provider Demographics
NPI:1114577244
Name:ABA CARES LLC
Entity Type:Organization
Organization Name:ABA CARES LLC
Other - Org Name:ABACARES SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-745-4214
Mailing Address - Street 1:PO BOX 6136
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-6136
Mailing Address - Country:US
Mailing Address - Phone:215-745-4214
Mailing Address - Fax:
Practice Address - Street 1:1619 GRANT AVE STE 17
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3166
Practice Address - Country:US
Practice Address - Phone:215-745-4214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA44923601OtherHOME CARE AGENCY LICENSE ID