Provider Demographics
NPI:1043005028
Name:ODABLE
Entity type:Organization
Organization Name:ODABLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GUGSA
Authorized Official - Middle Name:BACHA
Authorized Official - Last Name:GEMEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-576-9176
Mailing Address - Street 1:10579 DOMEYKITE VW
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-4539
Mailing Address - Country:US
Mailing Address - Phone:719-505-9155
Mailing Address - Fax:
Practice Address - Street 1:10579 DOMEYKITE VW
Practice Address - Street 2:
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80908-4539
Practice Address - Country:US
Practice Address - Phone:719-505-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle