Provider Demographics
NPI:1992007686
Name:ABJ ACTIVE LIFE HCS, INC.
Entity Type:Organization
Organization Name:ABJ ACTIVE LIFE HCS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:BOYAGON
Authorized Official - Last Name:BUTIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-894-4047
Mailing Address - Street 1:8902 CRAZY HORSE TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-7151
Mailing Address - Country:US
Mailing Address - Phone:281-894-4047
Mailing Address - Fax:281-894-4047
Practice Address - Street 1:8902 CRAZY HORSE TRL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-7151
Practice Address - Country:US
Practice Address - Phone:281-894-4047
Practice Address - Fax:281-894-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities