Healthcare Provider Details

I. General information

NPI: 1659989457
Provider Name (Legal Business Name): ABUDANT LIVING HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 PARK PLACE DR
CAPE GIRARDEAU MO
63703-6378
US

IV. Provider business mailing address

3151 PARK PLACE DR
CAPE GIRARDEAU MO
63703-6378
US

V. Phone/Fax

Practice location:
  • Phone: 573-579-4899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: PAMELA J. HIETT
Title or Position: RN, PROGRAM DIRECTOR
Credential: RN, RNFA
Phone: 573-579-4899