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General NPI Number Information
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NPI Number | 1457297228
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIVING SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 04/25/2026
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Last Update Date | 04/25/2026
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Provider Practice Location Address
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Address Line | 13145 SAPPHIRE RIDGE PL
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City | BRISTOW
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State | VA
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Zip | 20136-2309
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Country | US
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Telephone | 571-668-6862
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Fax |
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Provider Business Mailing Address
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Address Line | 13145 SAPPHIRE RIDGE PL
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City | BRISTOW
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State | VA
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Zip | 20136-2309
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Country | US
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Telephone | 571-668-6862
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AURORE PRISCILLA Y ASSOUMAN
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Credential | PA
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Telephone | 571-668-6862
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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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