Healthcare Provider Details

I. General information

NPI: 1952176752
Provider Name (Legal Business Name): ABUNDANT BEGINNINGS RESIDENTIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 W MISSION LN
PHOENIX AZ
85051-3256
US

IV. Provider business mailing address

6628 W ADAMS ST
PHOENIX AZ
85043-5069
US

V. Phone/Fax

Practice location:
  • Phone: 602-475-6982
  • Fax:
Mailing address:
  • Phone: 602-475-6982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS CANDACE CARTER
Title or Position: OWNER/PROGRAM DIRECTOR
Credential:
Phone: 602-475-6982