Healthcare Provider Details

I. General information

NPI: 1447827449
Provider Name (Legal Business Name): ABUNDANCE OF CARE HOME SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3596 NORMANDY RD
CLEVELAND OH
44120-5243
US

IV. Provider business mailing address

3596 NORMANDY RD
CLEVELAND OH
44120-5243
US

V. Phone/Fax

Practice location:
  • Phone: 707-755-6289
  • Fax:
Mailing address:
  • Phone: 707-755-6289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CARMEN BRUCE
Title or Position: OWNER
Credential: LPN
Phone: 707-755-6289