MEDICARE: ABAZINNIA ACQUIRED BRAIN INJURY SERVICES INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1497019285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABAZINNIA ACQUIRED BRAIN INJURY SERVICES INC

Provider Business Mailing Address
First Line	:	15 HUNTERS TRL
Second Line	:
City	:	SANDWICH
State	:	MA
Zip	:	02563-2701
Country	:	US
Telephone Number	:	774-487-1523
Fax Number	:	207-956-5799

Provider Business Practice Location Address
First Line	:	1167 CAPE RD
Second Line	:
City	:	HOLLIS CENTER
State	:	ME
Zip	:	04042-3037
Country	:	US
Telephone Number	:	207-370-2430
Fax Number	:	207-956-5799

Authorized Official
Title or Position	:	PRESIDENT, TREASURER
Name	:	JESSICA DUBOIS
Credential	:
Telephone Number	:	774-487-1523

Provider Enumeration Date	:	06/27/2012
Last Update Date	:	07/25/2019

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