MEDICARE: ABUNDANCE OF HOPE SERVICE LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1255206157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANCE OF HOPE SERVICE LLC

Provider Business Mailing Address
First Line	:	132 N SYCAMORE ST STE 15
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-3262
Country	:	US
Telephone Number	:	804-479-1127
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 N SYCAMORE ST STE 15
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-3262
Country	:	US
Telephone Number	:	804-479-1127
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. LEQUITA TIMS DAVIS
Credential	:	LPN
Telephone Number	:	804-479-1127

Provider Enumeration Date	:	10/09/2025
Last Update Date	:	10/09/2025

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