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General NPI Number Information
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NPI Number | 1487388930
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE CARE CLINIC LLC
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 516 N ROLLING RD STE 203
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City | CATONSVILLE
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State | MD
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Zip | 21228-4187
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Country | US
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Telephone | 216-925-9786
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Fax |
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Provider Business Mailing Address
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Address Line | 4317 JORDAN WAY
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City | PERRY HALL
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State | MD
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Zip | 21128-9859
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATIENCE M CHIA
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Credential | ARNP
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Telephone | 216-925-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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