Provider Demographics
NPI:1013091917
Name:ABBA COVENANT, INC
Entity Type:Organization
Organization Name:ABBA COVENANT, INC
Other - Org Name:KIDS @ LA MISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ESMERALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-849-5552
Mailing Address - Street 1:510 E BRAVO BLVD
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-5612
Mailing Address - Country:US
Mailing Address - Phone:956-849-5552
Mailing Address - Fax:956-847-1177
Practice Address - Street 1:510 E BRAVO BLVD
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-5612
Practice Address - Country:US
Practice Address - Phone:956-849-5552
Practice Address - Fax:956-847-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676584Medicare ID - Type UnspecifiedMEDICARE PROVIDER #