Provider Demographics
NPI:1669823977
Name:ABCD LLC
Entity Type:Organization
Organization Name:ABCD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-716-3421
Mailing Address - Street 1:18 W 1690 S
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-5649
Mailing Address - Country:US
Mailing Address - Phone:505-716-3421
Mailing Address - Fax:
Practice Address - Street 1:18 W 1690 S
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-5649
Practice Address - Country:US
Practice Address - Phone:505-716-3421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health