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General NPI Number Information
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NPI Number | 1265252811
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Entity Type | Organization
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Legal Business Name | ABUNDANCE CARE RESIDENTIAL ASSISTED LIVING
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 12619 KAVANAUGH LN
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City | BOWIE
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State | MD
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Zip | 20715-2816
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Country | US
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Telephone | 301-262-1657
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 S GLEBE RD UNIT 40592
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City | ARLINGTON
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State | VA
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Zip | 22204-0283
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Country | US
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Telephone | 703-861-0982
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | VALERIE LUCAS
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Credential |
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Telephone | 703-861-0982
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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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