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General NPI Number Information
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NPI Number | 1174759963
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE CENTER
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 2550 MAIN ST
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City | HARTFORD
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State | CT
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Zip | 06120-1936
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Country | US
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Telephone | 860-548-9399
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 714
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City | HARTFORD
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State | CT
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Zip | 06142-0714
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Country | US
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Telephone | 860-548-9399
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. TROY MOSES
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Credential | PRESINDENT
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Telephone | 860-548-9399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 001806
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 001806
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 104100000X
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License Number State | CT
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