Provider Demographics
NPI:1114613494
Name:ABOL HEALTHCARE LLC
Entity Type:Organization
Organization Name:ABOL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ESKEDAR
Authorized Official - Middle Name:ENYEW
Authorized Official - Last Name:KASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-495-9612
Mailing Address - Street 1:85 S BRAGG ST STE 200C
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2793
Mailing Address - Country:US
Mailing Address - Phone:703-270-9256
Mailing Address - Fax:
Practice Address - Street 1:85 S BRAGG ST STE 200C
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2793
Practice Address - Country:US
Practice Address - Phone:703-270-9256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care