Provider Demographics
NPI:1124636394
Name:ABC COMMUNITY SERVICES LLC
Entity type:Organization
Organization Name:ABC COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNPC
Authorized Official - Phone:678-237-7183
Mailing Address - Street 1:1622 ENGLISH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-3912
Mailing Address - Country:US
Mailing Address - Phone:317-434-5973
Mailing Address - Fax:770-872-8267
Practice Address - Street 1:1622 ENGLISH AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-3912
Practice Address - Country:US
Practice Address - Phone:317-434-5973
Practice Address - Fax:770-872-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty