Provider Demographics
NPI:1194498667
Name:ABL HOSPICE LLC
Entity type:Organization
Organization Name:ABL HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGUDAEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-562-8552
Mailing Address - Street 1:1601 BAYSHORE HWY STE 258
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1514
Mailing Address - Country:US
Mailing Address - Phone:415-562-8552
Mailing Address - Fax:650-479-8113
Practice Address - Street 1:6150 MISSION ST STE 103
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2063
Practice Address - Country:US
Practice Address - Phone:415-562-8552
Practice Address - Fax:650-479-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based