Provider Demographics
NPI:1164428702
Name:ABI CARE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:ABI CARE HOME HEALTH, LLC
Other - Org Name:ABICARE HOME HEALTH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLATUNBOSUN
Authorized Official - Middle Name:OLUSEGUN
Authorized Official - Last Name:OSUKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-241-2419
Mailing Address - Street 1:2974 LBJ FWY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7602
Mailing Address - Country:US
Mailing Address - Phone:972-241-2419
Mailing Address - Fax:
Practice Address - Street 1:2974 LBJ FWY
Practice Address - Street 2:SUITE 401
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7602
Practice Address - Country:US
Practice Address - Phone:972-241-2419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004704251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024197801Medicaid
TX0000HH9268OtherBCBS
TX024197801Medicaid