Healthcare Provider Details

I. General information

NPI: 1578054011
Provider Name (Legal Business Name): ABUNDANT LIFE CARE CENTER L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 MARGARET ST
DELAND FL
32720-6677
US

IV. Provider business mailing address

826 MARGARET ST
DELAND FL
32720-6677
US

V. Phone/Fax

Practice location:
  • Phone: 386-624-3270
  • Fax:
Mailing address:
  • Phone: 386-624-3270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SARAH JACOBS
Title or Position: OWNER
Credential:
Phone: 386-624-3270