MEDICARE: ABJ ACTIVE LIFE HCS 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	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1851787881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABJ ACTIVE LIFE HCS INC

Provider Business Mailing Address
First Line	:	8902 CRAZY HORSE TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-7151
Country	:	US
Telephone Number	:	832-656-6392
Fax Number	:

Provider Business Practice Location Address
First Line	:	8902 CRAZY HORSE TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-7151
Country	:	US
Telephone Number	:	832-656-6392
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARTHUR BOYAGON BUTIC
Credential	:
Telephone Number	:	832-656-6392

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	04/07/2015

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