Healthcare Provider Details

I. General information

NPI: 1073389615
Provider Name (Legal Business Name): ABUNDANT HANDS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8482 FORT SMALLWOOD RD # 224
PASADENA MD
21122-2763
US

IV. Provider business mailing address

8482 FORT SMALLWOOD RD # 224
PASADENA MD
21122-2763
US

V. Phone/Fax

Practice location:
  • Phone: 310-864-0271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TASHANAYE DUDLEY
Title or Position: PRESIDENT
Credential:
Phone: 310-864-0271