Healthcare Provider Details

I. General information

NPI: 1710285010
Provider Name (Legal Business Name): ABUNDANT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 PARK AVE STE 102
MEMPHIS TN
38119-3505
US

IV. Provider business mailing address

5200 PARK AVE STE 102
MEMPHIS TN
38119-3505
US

V. Phone/Fax

Practice location:
  • Phone: 901-820-0701
  • Fax: 901-820-0709
Mailing address:
  • Phone: 901-820-0701
  • Fax: 901-820-0709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1000000008243
License Number StateTN

VIII. Authorized Official

Name: JESSICA YVETTE MICKEY
Title or Position: PRESIDENT
Credential:
Phone: 901-820-0701