Provider Demographics
NPI:1972930915
Name:ABODE SERVICES
Entity type:Organization
Organization Name:ABODE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER OF ABODE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:ELMER
Authorized Official - Last Name:HARELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, PHD
Authorized Official - Phone:510-706-7519
Mailing Address - Street 1:40849 FREMONT BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-657-7409
Mailing Address - Fax:510-657-7293
Practice Address - Street 1:40849 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4306
Practice Address - Country:US
Practice Address - Phone:510-657-7409
Practice Address - Fax:510-657-7293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-05
Last Update Date:2013-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070824251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health