Provider Demographics
NPI:1922750173
Name:ABRAHAM HOME CARE PROVIDER LLC
Entity Type:Organization
Organization Name:ABRAHAM HOME CARE PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUDELKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-585-9298
Mailing Address - Street 1:807 BROAD ST RM 233
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:807 BROAD ST RM 233
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1678
Practice Address - Country:US
Practice Address - Phone:401-585-9298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care