Provider Demographics
NPI:1659327757
Name:ABBI HOME CARE, INC.
Entity Type:Organization
Organization Name:ABBI HOME CARE, INC.
Other - Org Name:ABBI HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MEDDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-377-0889
Mailing Address - Street 1:6453 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76132
Mailing Address - Country:US
Mailing Address - Phone:817-377-0889
Mailing Address - Fax:817-377-0890
Practice Address - Street 1:6453 SOUTHWEST BLVD.
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-377-0889
Practice Address - Fax:817-377-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009117251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673171Medicare Oscar/Certification