Provider Demographics
NPI:1225330590
Name:ABLEHOUSE LLC
Entity Type:Organization
Organization Name:ABLEHOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-432-7894
Mailing Address - Street 1:3765 OAK LN
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7519
Mailing Address - Country:US
Mailing Address - Phone:321-432-7894
Mailing Address - Fax:866-778-9848
Practice Address - Street 1:3765 OAK LN
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7519
Practice Address - Country:US
Practice Address - Phone:321-432-7894
Practice Address - Fax:866-778-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBC057382171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684605098Medicaid
FL684605096Medicaid