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General NPI Number Information
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NPI Number | 1285371419
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Entity Type | Organization
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Legal Business Name | ABUNDANCE HOME CARE SOURCE LLC
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 115 WHITE RD
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1203
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Country | US
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Telephone | 856-723-2227
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Fax |
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Provider Business Mailing Address
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Address Line | 154 RAINBOW WAY # 187
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-3994
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Country | US
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Telephone | 770-424-7700
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Fax | 470-691-1284
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | FELICITA WRIGHT
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Credential |
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Telephone | 856-723-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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