Provider Demographics
NPI:1699530485
Name:ABRA HEALTH LLC
Entity type:Organization
Organization Name:ABRA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DA'MOND
Authorized Official - Middle Name:O
Authorized Official - Last Name:GADSON
Authorized Official - Suffix:
Authorized Official - Credentials:DBH, LPC, MPC, MED
Authorized Official - Phone:602-518-0214
Mailing Address - Street 1:7214 W READE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-6124
Mailing Address - Country:US
Mailing Address - Phone:602-518-0214
Mailing Address - Fax:
Practice Address - Street 1:1401 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2315
Practice Address - Country:US
Practice Address - Phone:602-492-1875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child