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General NPI Number Information
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NPI Number | 1689487381
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Entity Type | Organization
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Legal Business Name | ABODE CARE PARTNERS LTC VB, LLC
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 4140 MCKNIGHT RD STE D
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City | TEXARKANA
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State | TX
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Zip | 75503-0921
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Country | US
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Telephone | 855-498-6767
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Fax |
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Provider Business Mailing Address
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Address Line | 805 N WHITTINGTON PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40222-7101
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Country | US
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Telephone | 800-866-0860
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT MANAGER
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Name | DENISHA CONNOR
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Credential |
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Telephone | 502-630-7421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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