Healthcare Provider Details

I. General information

NPI: 1801670088
Provider Name (Legal Business Name): ABUNDANT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 W PETERSON AVE STE 308
CHICAGO IL
60646-5753
US

IV. Provider business mailing address

4747 W PETERSON AVE STE 308
CHICAGO IL
60646-5753
US

V. Phone/Fax

Practice location:
  • Phone: 773-777-2273
  • Fax:
Mailing address:
  • Phone: 773-777-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY SISON
Title or Position: OWNER
Credential:
Phone: 773-777-2273