Healthcare Provider Details

I. General information

NPI: 1790516920
Provider Name (Legal Business Name): ABUNDANT LIFE COMMUNITY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/29/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 S SIERRA MADRE ST. SUITE L
COLORADO SPRINGS CO
80903-3399
US

IV. Provider business mailing address

76 S SIERRA MADRE ST. SUITE L
COLORADO SPRINGS CO
80903-3399
US

V. Phone/Fax

Practice location:
  • Phone: 719-246-0170
  • Fax:
Mailing address:
  • Phone: 719-246-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. RACHEL LASSITER
Title or Position: CEO
Credential: HS-BCP
Phone: 719-246-0170