Provider Demographics
NPI:1215529391
Name:ABRAHAM HOME CARE LLC
Entity type:Organization
Organization Name:ABRAHAM HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-650-0618
Mailing Address - Street 1:2521 N MAIN ST # 1-121
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1154
Mailing Address - Country:US
Mailing Address - Phone:575-650-0351
Mailing Address - Fax:
Practice Address - Street 1:509 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1260
Practice Address - Country:US
Practice Address - Phone:575-650-0618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty