Healthcare Provider Details

I. General information

NPI: 1013091917
Provider Name (Legal Business Name): ABBA COVENANT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E BRAVO BLVD
ROMA TX
78584-5612
US

IV. Provider business mailing address

510 E BRAVO BLVD
ROMA TX
78584-5612
US

V. Phone/Fax

Practice location:
  • Phone: 956-849-5552
  • Fax: 956-847-1177
Mailing address:
  • Phone: 956-849-5552
  • Fax: 956-847-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ESMERALDA CHAVEZ
Title or Position: CEO
Credential:
Phone: 956-849-5552