Provider Demographics
NPI:1457363251
Name:ABODE HOME HEALTH CARE
Entity Type:Organization
Organization Name:ABODE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:KUTTIPARAMBIL
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-733-7873
Mailing Address - Street 1:2023 HILLCREST ST
Mailing Address - Street 2:SUITE 1086
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1685
Mailing Address - Country:US
Mailing Address - Phone:469-733-7873
Mailing Address - Fax:972-290-4702
Practice Address - Street 1:2023 HILLCREST ST
Practice Address - Street 2:SUITE 1086
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1685
Practice Address - Country:US
Practice Address - Phone:469-733-7873
Practice Address - Fax:972-290-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010638251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010638OtherLICENSED HOME HEALTH SERV