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General NPI Number Information
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NPI Number | 1134563257
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE HOME HEALTH SERVICES, INC
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 5712 HARFORD RD
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City | BALTIMORE
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State | MD
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Zip | 21214-2235
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Country | US
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Telephone | 410-917-9433
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Fax |
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Provider Business Mailing Address
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Address Line | 5712 HARDFORD RD
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City | BALTIMORE
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State | MD
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Zip | 21214
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Country | US
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Telephone | 410-917-9433
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BOSEDE DANIYAN
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Credential |
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Telephone | 410-917-9433
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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 | RS3406P
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License Number State | MD
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