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General NPI Number Information
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NPI Number | 1568810430
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE COMMUNITY DEVELOPMENT CORPORATION
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 12/09/2016
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Provider Practice Location Address
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Address Line | 24 BLEVINS DR
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City | NEW CASTLE
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State | DE
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Zip | 19720-4152
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Country | US
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Telephone | 302-983-6436
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Fax |
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Provider Business Mailing Address
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Address Line | 24 BLEVINS DR
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City | NEW CASTLE
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State | DE
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Zip | 19720-4152
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Country | US
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Telephone | 302-983-6436
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELLIS FAGBAMI
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Credential |
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Telephone | 302-983-6436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training 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 | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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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 | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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