Healthcare Provider Details

I. General information

NPI: 1003741786
Provider Name (Legal Business Name): ABUNDANT LIFE EMPLOYMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 W JEWELL ST
BOISE ID
83704-8237
US

IV. Provider business mailing address

9325 W JEWELL ST
BOISE ID
83704-8237
US

V. Phone/Fax

Practice location:
  • Phone: 208-912-2956
  • Fax: 208-912-2956
Mailing address:
  • Phone: 208-912-2956
  • Fax: 208-912-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: TRACY MADENFORD
Title or Position: OWNER
Credential:
Phone: 208-912-2956