Provider Demographics
| NPI: | 1114581386 |
|---|---|
| Name: | ABRA HEALTH LLC |
| Entity Type: | Organization |
| Organization Name: | ABRA HEALTH LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | DA'MOND |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | GADSON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | DBH, LPC, MED |
| Authorized Official - Phone: | 602-518-0214 |
| Mailing Address - Street 1: | 7214 W READE AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | GLENDALE |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85303-6124 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 602-518-0214 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 8636 N 59TH AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | GLENDALE |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85302-5404 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 602-518-0214 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-04-23 |
| Last Update Date: | 2020-08-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 251E00000X | Agencies | Home Health | ||
| No | 251K00000X | Agencies | Public Health or Welfare | ||
| No | 253Z00000X | Agencies | In Home Supportive Care | ||
| No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AZ | 008085 | Medicaid |
