Provider Demographics
NPI:1104420686
Name:ABO, LLC
Entity type:Organization
Organization Name:ABO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-830-6400
Mailing Address - Street 1:11429 SAINT CHARLES ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2724
Mailing Address - Country:US
Mailing Address - Phone:314-830-6400
Mailing Address - Fax:314-830-6405
Practice Address - Street 1:11429 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2724
Practice Address - Country:US
Practice Address - Phone:314-830-6400
Practice Address - Fax:314-830-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care