Healthcare Provider Details

I. General information

NPI: 1205317443
Provider Name (Legal Business Name): ABUNDANT HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2018
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 CAHILL DR
WINSTON SALEM NC
27127-8827
US

IV. Provider business mailing address

1880 CAHILL DR
WINSTON SALEM NC
27127-8827
US

V. Phone/Fax

Practice location:
  • Phone: 336-448-9989
  • Fax:
Mailing address:
  • Phone: 336-448-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENERIA D SHEPHERD
Title or Position: OWNER
Credential:
Phone: 336-448-9989