Provider Demographics
NPI:1790543916
Name:A.B.K. KLEANER LLC.
Entity Type:Organization
Organization Name:A.B.K. KLEANER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHID HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-703-9008
Mailing Address - Street 1:168 EXPEDITION DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2274
Mailing Address - Country:US
Mailing Address - Phone:770-703-9008
Mailing Address - Fax:
Practice Address - Street 1:168 EXPEDITION DR
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2274
Practice Address - Country:US
Practice Address - Phone:770-703-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service