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General NPI Number Information
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NPI Number | 1598037426
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE ASSISTED SERAVICES INC
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 10800 ALPHARETTA HWY SUITE 208- 713
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City | ROSWELL
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State | GA
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Zip | 30076-1490
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Country | US
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Telephone | 678-319-0307
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Fax | 678-319-0307
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Provider Business Mailing Address
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Address Line | 10800 ALPHARETTA HWY SUITE 208- 713
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City | ROSWELL
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State | GA
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Zip | 30076-4621
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Country | US
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Telephone | 678-319-0307
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Fax | 678-319-0307
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. REBECCA M AIDOO I
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Credential | CNA
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Telephone | 678-319-0307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 060-R-0501
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License Number State | GA
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