Healthcare Provider Details

I. General information

NPI: 1154254183
Provider Name (Legal Business Name): ABODE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 BENNETT VALLEY RD
SANTA ROSA CA
95404-5514
US

IV. Provider business mailing address

40849 FREMONT BLVD
FREMONT CA
94538-4306
US

V. Phone/Fax

Practice location:
  • Phone: 510-657-7409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SHERMAN WONG
Title or Position: QUALITY ASSURANCE COORDINATOR
Credential:
Phone: 510-270-1150