Healthcare Provider Details

I. General information

NPI: 1114208360
Provider Name (Legal Business Name): ABBA HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SOUTHBRIDGE ST STE 310
WORCESTER MA
01608-2037
US

IV. Provider business mailing address

40 SOUTHBRIDGE ST STE 310
WORCESTER MA
01608-2037
US

V. Phone/Fax

Practice location:
  • Phone: 508-630-4514
  • Fax: 508-966-7098
Mailing address:
  • Phone: 508-630-4514
  • Fax: 508-966-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1190093428D
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: DELMARIS ROSSO
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 508-630-4514