=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336830074
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABJA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2023
-----------------------------------------------------
Last Update Date | 10/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21815 OAK PARK TRAILS DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-6184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-832-8365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21815 OAK PARK TRAILS DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-6184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-832-8365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | ARNOLD BARRERA III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 345-254-4679
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------