MEDICARE: 1 ABLE BLUE GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
3	385H00000X	Respite Care
4	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1366386898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1 ABLE BLUE GROUP LLC

Provider Business Mailing Address
First Line	:	2903 SKYLINE MESA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-2102
Country	:	US
Telephone Number	:	347-894-6788
Fax Number	:

Provider Business Practice Location Address
First Line	:	2903 SKYLINE MESA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-2102
Country	:	US
Telephone Number	:	347-894-6788
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	RACHID NOMBRE
Credential	:
Telephone Number	:	347-894-6788

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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