Provider Demographics
NPI:1659502755
Name:ABITACARE, LLC
Entity Type:Organization
Organization Name:ABITACARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GILCHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-482-4003
Mailing Address - Street 1:1501 23RD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4027
Mailing Address - Country:US
Mailing Address - Phone:877-229-1724
Mailing Address - Fax:877-229-1725
Practice Address - Street 1:1501 23RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4027
Practice Address - Country:US
Practice Address - Phone:877-229-1724
Practice Address - Fax:877-229-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 332B00000X, 332BP3500X
MS08206/01.1333600000X
MS08206113336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00473225Medicaid
AL114674Medicaid
MS7589870001OtherDMEPOS