Provider Demographics
NPI:1649044744
Name:ABA HOMECARE LLC
Entity type:Organization
Organization Name:ABA HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENAI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:678-389-1881
Mailing Address - Street 1:1775 PARKER RD SE STE 210
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6654
Mailing Address - Country:US
Mailing Address - Phone:678-389-1881
Mailing Address - Fax:
Practice Address - Street 1:1775 PARKER ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094
Practice Address - Country:US
Practice Address - Phone:678-389-1881
Practice Address - Fax:800-480-8076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health