Provider Demographics
NPI:1144105099
Name:EGHAREVBA, ABIES RACHAEL
Entity type:Individual
Prefix:
First Name:ABIES
Middle Name:RACHAEL
Last Name:EGHAREVBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 ACORN GLEN TRL
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-2144
Mailing Address - Country:US
Mailing Address - Phone:832-805-6419
Mailing Address - Fax:
Practice Address - Street 1:1707 ACORN GLEN TRL
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-2144
Practice Address - Country:US
Practice Address - Phone:832-805-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances