Provider Demographics
NPI:1508276874
Name:ABBISTON CORP
Entity Type:Organization
Organization Name:ABBISTON CORP
Other - Org Name:FIRSTLIGHT HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER / VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-445-6171
Mailing Address - Street 1:2110 S BENTLEY AVE
Mailing Address - Street 2:APT 303
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5764
Mailing Address - Country:US
Mailing Address - Phone:310-445-6171
Mailing Address - Fax:310-445-6172
Practice Address - Street 1:2110 S BENTLEY AVE
Practice Address - Street 2:APT 303
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5764
Practice Address - Country:US
Practice Address - Phone:310-445-6171
Practice Address - Fax:310-445-6172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care