Healthcare Provider Details

I. General information

NPI: 1700196995
Provider Name (Legal Business Name): ABUNDANT HOME HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 HERITAGE DR STE 102
BOURBONNAIS IL
60914-1369
US

IV. Provider business mailing address

19 HERITAGE PLAZA SUITE102
BOURBONNAIS IL
60914-1369
US

V. Phone/Fax

Practice location:
  • Phone: 815-932-1600
  • Fax: 815-932-1602
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL UDONKANG
Title or Position: ADMINISTRATOR
Credential:
Phone: 815-932-1600