Healthcare Provider Details

I. General information

NPI: 1588217822
Provider Name (Legal Business Name): ABUNDANT CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 TAYLOR AVE STE 15
TOWSON MD
21286-8328
US

IV. Provider business mailing address

1045 TAYLOR AVE STE 15
TOWSON MD
21286-8328
US

V. Phone/Fax

Practice location:
  • Phone: 410-888-7167
  • Fax: 667-308-2985
Mailing address:
  • Phone: 410-888-7167
  • Fax: 667-308-2985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL O ODETOYE
Title or Position: ADMIN. MANAGER
Credential:
Phone: 410-888-7167