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General NPI Number Information
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NPI Number | 1598580730
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Entity Type | Organization
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Legal Business Name | ABUNDANTLY BLESSED LLL
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 6650 RIVERS AVE
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-4809
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Country | US
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Telephone | 843-268-8364
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Fax | 843-268-8372
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Provider Business Mailing Address
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Address Line | 2910 EDGMONT AVE
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City | BROOKHAVEN
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State | PA
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Zip | 19015-3236
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Country | US
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Telephone | 215-375-3939
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Fax | 215-475-6097
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LADONNA D SHAW-WRAGG
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Credential |
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Telephone | 215-906-0911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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