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General NPI Number Information
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NPI Number | 1851633036
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Entity Type | Organization
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Legal Business Name | ABUNDANCE HOME CARE, INC.
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 3030 HARBOR LN N SUITE #124
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City | PLYMOUTH
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State | MN
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Zip | 55447-5110
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Country | US
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Telephone | 763-315-1050
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Fax | 763-315-1090
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Provider Business Mailing Address
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Address Line | 3030 HARBOR LN N SUITE #124
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City | PLYMOUTH
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State | MN
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Zip | 55447-5110
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Country | US
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Telephone | 763-315-1050
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Fax | 763-315-1090
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Authorized Official
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Title or Position | CEO
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Name | MR. WILLIAM ALDRICH WALTERS
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Credential | BA
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Telephone | 763-315-1050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 29273
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License Number State | MN
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