=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821517061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABUNDANCE OF LIFE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2017
-----------------------------------------------------
Last Update Date | 08/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2602 W SILVER SPRING DR SUITE 200
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53209-4292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-256-5000
-----------------------------------------------------
Fax | 844-274-3572
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 101009
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53210-7009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-256-5000
-----------------------------------------------------
Fax | 844-274-3572
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | NATALIA YOUNG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-737-0708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------