Healthcare Provider Details

I. General information

NPI: 1255756508
Provider Name (Legal Business Name): ABACO HOUSE A.L.F,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ABACO DR
PALM SPRINGS FL
33461-2001
US

IV. Provider business mailing address

121 ABACO DR
PALM SPRINGS FL
33461-2001
US

V. Phone/Fax

Practice location:
  • Phone: 561-891-3095
  • Fax:
Mailing address:
  • Phone: 561-891-3095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAL11839
License Number StateFL

VIII. Authorized Official

Name: MARIA SANTANA
Title or Position: ADMINISTRATOR/ONWER
Credential:
Phone: 561-891-3095