Healthcare Provider Details

I. General information

NPI: 1013360619
Provider Name (Legal Business Name): ABBAS CONSTRUCTION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 JUBILANT PL
COLORADO SPRINGS CO
80917-2513
US

IV. Provider business mailing address

3590 JUBILANT PL
COLORADO SPRINGS CO
80917-2513
US

V. Phone/Fax

Practice location:
  • Phone: 719-491-0691
  • Fax: 719-591-2140
Mailing address:
  • Phone: 719-491-0691
  • Fax: 719-591-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number21547
License Number StateCO

VIII. Authorized Official

Name: MR. JOSE P VILLARRUEL
Title or Position: OWNER
Credential:
Phone: 719-491-0691