MEDICARE: ABUNDANT LIFE NURSING 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	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356813885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT LIFE NURSING LLC

Provider Business Mailing Address
First Line	:	2280 W OLD US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-3508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2799 W OLD US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-3536
Country	:	US
Telephone Number	:	352-250-2748
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	PATRICIA ALLEN
Credential	:
Telephone Number	:	352-250-2748

Provider Enumeration Date	:	12/21/2018
Last Update Date	:	05/29/2024

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