Healthcare Provider Details

I. General information

NPI: 1417413949
Provider Name (Legal Business Name): ABEL'S HOUSE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 W PEORIA AVE
PHOENIX AZ
85029-5984
US

IV. Provider business mailing address

1930 W WASHINGTON ST
PHOENIX AZ
85009-5209
US

V. Phone/Fax

Practice location:
  • Phone: 602-441-0956
  • Fax:
Mailing address:
  • Phone: 602-441-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MONICA J MEDRANO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 602-441-0956