Provider Demographics
NPI:1255568978
Name:ABBA GENTLE HEALTHCARE LLC
Entity type:Organization
Organization Name:ABBA GENTLE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:
Authorized Official - First Name:LANI
Authorized Official - Middle Name:CABRAL
Authorized Official - Last Name:PASAO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-276-3033
Mailing Address - Street 1:11110 BELLAIRE BLVD #226
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072
Mailing Address - Country:US
Mailing Address - Phone:832-369-6811
Mailing Address - Fax:281-561-8927
Practice Address - Street 1:11110 BELLAIRE BOULEVARD
Practice Address - Street 2:SUITE 226
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-7707
Practice Address - Country:US
Practice Address - Phone:832-276-3033
Practice Address - Fax:281-561-8927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012948251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2916280-01Medicaid
TX74-7580Medicare PIN
TX2916280-01Medicaid