Provider Demographics
NPI:1366229114
Name:ABENEZA HOME CARE LLC
Entity type:Organization
Organization Name:ABENEZA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOTHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-400-5238
Mailing Address - Street 1:15513 SPOTTED EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621
Mailing Address - Country:US
Mailing Address - Phone:512-400-5238
Mailing Address - Fax:
Practice Address - Street 1:15513 SPOTTED EAGLE LN
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621
Practice Address - Country:US
Practice Address - Phone:512-400-5238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care
No251B00000XAgenciesCase Management