MEDICARE: ABLEHOUSE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	CBC057382	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225330590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABLEHOUSE LLC

Provider Business Mailing Address
First Line	:	3765 OAK LN
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32934-7519
Country	:	US
Telephone Number	:	321-432-7894
Fax Number	:	866-778-9848

Provider Business Practice Location Address
First Line	:	3765 OAK LN
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32934-7519
Country	:	US
Telephone Number	:	321-432-7894
Fax Number	:	866-778-9848

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BRADLEY A. SHEA
Credential	:
Telephone Number	:	321-432-7894

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	11/18/2010

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Directions to “ABLEHOUSE LLC ” Practice Location

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