Provider Demographics
NPI:1386831162
Name:ABG PROFESSIONAL HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:ABG PROFESSIONAL HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-554-5234
Mailing Address - Street 1:8300 W FLAGLER ST
Mailing Address - Street 2:SUITE 256
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-6000
Mailing Address - Country:US
Mailing Address - Phone:305-554-5234
Mailing Address - Fax:305-554-5235
Practice Address - Street 1:8300 W FLAGLER ST
Practice Address - Street 2:SUITE 256
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-6000
Practice Address - Country:US
Practice Address - Phone:305-554-5234
Practice Address - Fax:305-554-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992890251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651741200Medicaid
FL1386831162Medicare UPIN