Healthcare Provider Details

I. General information

NPI: 1700046711
Provider Name (Legal Business Name): AN ABUNDANT LIFE HOME HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 W 84TH ST SUITE A
HIALEAH FL
33014-3617
US

IV. Provider business mailing address

680 W 84TH ST SUITE A
HIALEAH FL
33014-3617
US

V. Phone/Fax

Practice location:
  • Phone: 305-722-2234
  • Fax: 305-819-4416
Mailing address:
  • Phone: 305-722-2234
  • Fax: 305-819-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL

VIII. Authorized Official

Name: LAURA TIRSE
Title or Position: PRESIDENT
Credential:
Phone: 305-722-2234