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General NPI Number Information
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NPI Number | 1073182424
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Entity Type | Organization
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Legal Business Name | ABUNDANT GRACE HOME CARE LLC
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 9051 MANSFIELD RD STE B7
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City | SHREVEPORT
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State | LA
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Zip | 71118-2666
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Country | US
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Telephone | 318-773-4845
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Fax | 318-716-1024
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Provider Business Mailing Address
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Address Line | 1651 E 70TH ST # 264
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City | SHREVEPORT
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State | LA
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Zip | 71105-5115
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Country | US
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Telephone | 318-773-4845
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Fax | 318-716-1024
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Authorized Official
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Title or Position | OWNER/CEO/DON
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Name | KIERRA DEGALE YOUNGBLOOD
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Credential | RN
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Telephone | 318-773-4845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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