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General NPI Number Information
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NPI Number | 1003762014
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE ASSISTED LIVING LLC
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 1201 W 75TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90044-2405
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Country | US
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Telephone | 310-926-7574
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Fax |
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Provider Business Mailing Address
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Address Line | 7252 ARCHIBALD AVE # 543
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-5017
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Country | US
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Telephone | 310-926-7574
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Fax |
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Authorized Official
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Title or Position | LICENSEE
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Name | QUIANNA STREET
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Credential |
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Telephone | 310-696-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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