=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356925655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABUNDANCE OF LOVE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2021
-----------------------------------------------------
Last Update Date | 05/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3383 GRAYSTONE DR
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43232-5719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-509-1462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9090 HANOVER ST
-----------------------------------------------------
City | LITHIA SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30122-6412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-509-1462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE MANAGER
-----------------------------------------------------
Name | MR. DEMOND MARTIN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 513-578-2706
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------