Healthcare Provider Details

I. General information

NPI: 1922750173
Provider Name (Legal Business Name): ABRAHAM HOME CARE PROVIDER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BUCKLIN ST # 3
PROVIDENCE RI
02907-2547
US

IV. Provider business mailing address

25 BUCKLIN ST # 3
PROVIDENCE RI
02907-2547
US

V. Phone/Fax

Practice location:
  • Phone: 401-585-9298
  • Fax:
Mailing address:
  • Phone: 401-443-4008
  • Fax: 401-563-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: YUDELKA BERROA
Title or Position: OWNER
Credential:
Phone: 401-585-9298