Healthcare Provider Details

I. General information

NPI: 1518911692
Provider Name (Legal Business Name): ABBA COVENENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N TEXAS ST
RIO GRANDE TX
78582-3628
US

IV. Provider business mailing address

104 N TEXAS ST
RIO GRANDE TX
78582-3628
US

V. Phone/Fax

Practice location:
  • Phone: 956-488-1440
  • Fax: 956-847-1177
Mailing address:
  • Phone: 956-488-1440
  • Fax: 956-847-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ESMERALDA CHAVEZ
Title or Position: OWNER
Credential:
Phone: 956-488-1440