Healthcare Provider Details

I. General information

NPI: 1497075055
Provider Name (Legal Business Name): ABUNDANT LIFE ADULT DAY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5961 BULLARD AVE. SUITE 5 AND 6
NEW ORLEANS LA
70128-2817
US

IV. Provider business mailing address

5961 BULLARD AVE. SUITE 5 AND 6
NEW ORLEANS LA
70128-2817
US

V. Phone/Fax

Practice location:
  • Phone: 504-240-2900
  • Fax: 504-241-6000
Mailing address:
  • Phone: 504-240-2900
  • Fax: 504-241-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number5053
License Number StateLA

VIII. Authorized Official

Name: MS. HERLANIUS TATE
Title or Position: ADMINISTRATOR
Credential:
Phone: 504-415-9390