Healthcare Provider Details

I. General information

NPI: 1992621171
Provider Name (Legal Business Name): ABAHB HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 S BROADWAY ST APT 2239
CARROLLTON TX
75006-0042
US

IV. Provider business mailing address

1415 S BROADWAY ST APT 2239
CARROLLTON TX
75006-0042
US

V. Phone/Fax

Practice location:
  • Phone: 443-333-0039
  • Fax: 443-333-0039
Mailing address:
  • Phone: 443-333-0039
  • Fax: 443-333-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JULIUS FOMBAN PETNYIN
Title or Position: OWNER
Credential:
Phone: 443-333-0039