MEDICARE: ABUNDANT CARE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1104989565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	12100 S HIGHWAY 6
Second Line	:	8109
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-5712
Country	:	US
Telephone Number	:	281-498-2370
Fax Number	:	281-498-2370

Provider Business Practice Location Address
First Line	:	12100 S HIGHWAY 6
Second Line	:	8109
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-5712
Country	:	US
Telephone Number	:	281-498-2370
Fax Number	:	281-498-2370

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. GEORGE ABAYOMI OGUNNAIKE
Credential	:
Telephone Number	:	281-498-2370

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/22/2020

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