=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891300737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABASAP HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2020
-----------------------------------------------------
Last Update Date | 09/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 E ARAPAHO RD APT 22207
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75081-7708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-670-6238
-----------------------------------------------------
Fax | 214-613-6515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 E ARAPAHO RD APT 22207
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75081-7708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-670-6238
-----------------------------------------------------
Fax | 214-613-6515
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MIRIAM E KIMA
-----------------------------------------------------
Credential | HHA
-----------------------------------------------------
Telephone | 972-670-6238
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------