Provider Demographics
NPI:1639818859
Name:AB COMPASSIONATE SERVICES
Entity Type:Organization
Organization Name:AB COMPASSIONATE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BROKENBOROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-594-0057
Mailing Address - Street 1:5942 PARK HAMILTON BLVD APT 40
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-4117
Mailing Address - Country:US
Mailing Address - Phone:321-594-0057
Mailing Address - Fax:
Practice Address - Street 1:1224 CARLSBAD PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7312
Practice Address - Country:US
Practice Address - Phone:321-594-0057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1053Medicaid