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NPI Code Detail

MEDICARE: ABIES R. EGHAREVBA

MEDICARE: ABIES R. EGHAREVBA
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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1720936925
Entity Type Code : Organization
Provider Name (Legal Business Name) : ABIES R. EGHAREVBA
Provider Business Mailing Address
First Line : 1707 ACORN GLEN TRL
Second Line :
City : FRESNO
State : TX
Zip : 77545-2144
Country : US
Telephone Number : 832-805-6419
Fax Number :
Provider Business Practice Location Address
First Line : 1707 ACORN GLEN TRL
Second Line :
City : FRESNO
State : TX
Zip : 77545-2144
Country : US
Telephone Number : 832-805-6419
Fax Number :
Authorized Official
Title or Position : PROGRAM MANAGER
Name : ABIES EGHAREVBA
Credential :
Telephone Number : 832-805-6419
Provider Enumeration Date : 03/21/2026
Last Update Date : 03/21/2026

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