Provider Demographics
NPI:1568580645
Name:ABILIS INC
Entity Type:Organization
Organization Name:ABILIS INC
Other - Org Name:ABILIS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-531-1880
Mailing Address - Street 1:50 GLENVILLE STREET
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831
Mailing Address - Country:US
Mailing Address - Phone:203-531-1880
Mailing Address - Fax:203-531-9367
Practice Address - Street 1:15 CROSS RIDGE
Practice Address - Street 2:GARC
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870
Practice Address - Country:US
Practice Address - Phone:203-698-0683
Practice Address - Fax:203-637-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR669315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000066698Medicaid