Healthcare Provider Details

I. General information

NPI: 1518797489
Provider Name (Legal Business Name): ABUNDANCE OF LOVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 VIRGINIA PARK ST
DETROIT MI
48206-2420
US

IV. Provider business mailing address

7436 OAKLAND ST # 1021
DETROIT MI
48211-1352
US

V. Phone/Fax

Practice location:
  • Phone: 313-434-8004
  • Fax:
Mailing address:
  • Phone: 313-434-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. EVITA BAILEY
Title or Position: OWNER
Credential:
Phone: 313-434-8004