Provider Demographics
NPI:1871812859
Name:ABOVE AND BEYOND HABILITATION SERVICES
Entity type:Organization
Organization Name:ABOVE AND BEYOND HABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALEISHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-386-9232
Mailing Address - Street 1:1931 WELBY WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4462
Mailing Address - Country:US
Mailing Address - Phone:850-386-9232
Mailing Address - Fax:850-562-5257
Practice Address - Street 1:1931 WELBY WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4462
Practice Address - Country:US
Practice Address - Phone:850-386-9232
Practice Address - Fax:850-562-5257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-29
Last Update Date:2010-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL688118196343900000X, 372600000X, 3747A0650X, 3747P1801X, 374U00000X
FL688118198343900000X
FL688118101376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688118196Medicaid
FL688118101Medicaid
FL688118198Medicaid