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General NPI Number Information
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NPI Number | 1699530485
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Entity Type | Organization
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Legal Business Name | ABRA HEALTH LLC
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Dates
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Enumeration Date | 02/20/2024
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 1401 E JEFFERSON ST
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City | PHOENIX
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State | AZ
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Zip | 85034-2315
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Country | US
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Telephone | 602-492-1875
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Fax |
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Provider Business Mailing Address
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Address Line | 7214 W READE AVE
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City | GLENDALE
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State | AZ
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Zip | 85303-6124
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Country | US
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Telephone | 602-518-0214
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DA'MOND O GADSON
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Credential | DBH, LPC, MPC, MED
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Telephone | 602-518-0214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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