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General NPI Number Information
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NPI Number | 1760115216
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Entity Type | Organization
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Legal Business Name | ABUNDANCE HOME CARE LLC
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 319 N 4TH ST STE 604
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City | SAINT LOUIS
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State | MO
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Zip | 63102-1907
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Country | US
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Telephone | 636-633-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 319 N 4TH ST STE 604
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City | SAINT LOUIS
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State | MO
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Zip | 63102-1907
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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 | EXECUTIVE DIRECTOR
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Name | DEBRA GANT
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Credential |
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Telephone | 636-633-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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