Healthcare Provider Details

I. General information

NPI: 1164306429
Provider Name (Legal Business Name): ABUNDANT GRACE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 W LLOYD ST
MILWAUKEE WI
53208-1439
US

IV. Provider business mailing address

3223 W LLOYD ST
MILWAUKEE WI
53208-1439
US

V. Phone/Fax

Practice location:
  • Phone: 414-210-2669
  • Fax:
Mailing address:
  • Phone: 414-210-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: BARBARA ANDERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 414-210-2669