MEDICARE: ANABI SUPPORT COORDINATION AGENCY

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	171M00000X	Case Manager/Care Coordinator		FL

General Provider Information

NPI Number	:	1801963293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANABI SUPPORT COORDINATION AGENCY

Provider Business Mailing Address
First Line	:	2135 S.E. 17TH PLACE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990
Country	:	US
Telephone Number	:	239-573-5918
Fax Number	:	239-573-9595

Provider Business Practice Location Address
First Line	:	2135 SE 17TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-4725
Country	:	US
Telephone Number	:	239-573-5918
Fax Number	:	239-573-9595

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ABIBA G JIMMA
Credential	:
Telephone Number	:	239-573-5918

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	08/22/2020

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