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General NPI Number Information
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NPI Number | 1104362631
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Entity Type | Organization
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Legal Business Name | ABUNDANT NURSING CARE
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Dates
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Enumeration Date | 01/08/2017
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Last Update Date | 01/08/2017
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Provider Practice Location Address
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Address Line | 6230 TANGLEWOOD DR
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City | JACKSON
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State | MS
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Zip | 39213-7937
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Country | US
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Telephone | 601-421-2022
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Fax |
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Provider Business Mailing Address
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Address Line | 445 LAFAYETTE AVE.
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City | FAYETTEVILLE
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State | GA
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Zip | 30214
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Country | US
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Telephone | 601-421-2022
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Fax |
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Authorized Official
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Title or Position | CEO, ADMINISTRATIVE DIRECTOR
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Name | MRS. LASHELIA SHANTA BROWN
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Credential |
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Telephone | 407-304-6419
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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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