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General NPI Number Information
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NPI Number | 1891279410
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE MINISTRIES-HOPE HOUSE, INC.
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 25 OLD KINGS RD N STE 7B
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City | PALM COAST
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State | FL
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Zip | 32137-8245
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Country | US
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Telephone | 386-597-2861
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 354925
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City | PALM COAST
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State | FL
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Zip | 32135-4925
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Country | US
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Telephone | 386-597-2861
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Fax | 386-447-4580
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Authorized Official
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Title or Position | CEO
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Name | SANDRA SHANK
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Credential |
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Telephone | 386-597-2861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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