Healthcare Provider Details

I. General information

NPI: 1407296460
Provider Name (Legal Business Name): ABUNDANT LIVING CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2013
Last Update Date: 07/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N MONROE ST
ALBANY GA
31701-2292
US

IV. Provider business mailing address

118 7TH AVE NW
CAIRO GA
39828-2071
US

V. Phone/Fax

Practice location:
  • Phone: 229-420-7788
  • Fax:
Mailing address:
  • Phone: 229-327-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICIA KAY BYRDEN
Title or Position: SOCIAL WORKER
Credential: MS
Phone: 229-352-6560