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General NPI Number Information
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NPI Number | 1366341125
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE COMMUNITY SUPPORT SERVICES
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Dates
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Enumeration Date | 11/05/2026
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Last Update Date | 11/05/2026
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Provider Practice Location Address
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Address Line | 2807 42ND ST STE 100
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City | LUBBOCK
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State | TX
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Zip | 79413-2008
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Country | US
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Telephone | 806-544-9479
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Fax |
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Provider Business Mailing Address
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Address Line | 9703 RIDGELY AVE
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City | LUBBOCK
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State | TX
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Zip | 79424-7586
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Country | US
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Telephone | 806-544-9479
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASMINE RAE RODRIGUEZ
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Credential | BS
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Telephone | 806-544-9479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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