Provider Demographics
NPI:1801963293
Name:ANABI SUPPORT COORDINATION AGENCY
Entity type:Organization
Organization Name:ANABI SUPPORT COORDINATION AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ABIBA
Authorized Official - Middle Name:G
Authorized Official - Last Name:JIMMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-573-5918
Mailing Address - Street 1:2135 S.E. 17TH PLACE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990
Mailing Address - Country:US
Mailing Address - Phone:239-573-5918
Mailing Address - Fax:239-573-9595
Practice Address - Street 1:2135 SE 17TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-4725
Practice Address - Country:US
Practice Address - Phone:239-573-5918
Practice Address - Fax:239-573-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty