Provider Demographics
NPI:1770188013
Name:ABS HUMBLE HOME LLC
Entity Type:Organization
Organization Name:ABS HUMBLE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBRAHEEM
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-564-3771
Mailing Address - Street 1:7159 HAZELWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1659
Mailing Address - Country:US
Mailing Address - Phone:786-564-3771
Mailing Address - Fax:909-474-9486
Practice Address - Street 1:14798 CAMBRIA ST
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-2520
Practice Address - Country:US
Practice Address - Phone:786-564-3771
Practice Address - Fax:909-474-9486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility