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General NPI Number Information
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NPI Number | 1952176752
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Entity Type | Organization
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Legal Business Name | ABUNDANT BEGINNINGS RESIDENTIAL CARE LLC
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Dates
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Enumeration Date | 11/21/2023
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 4207 W MISSION LN
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City | PHOENIX
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State | AZ
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Zip | 85051-3256
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Country | US
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Telephone | 602-475-6982
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Fax |
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Provider Business Mailing Address
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Address Line | 6628 W ADAMS ST
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City | PHOENIX
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State | AZ
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Zip | 85043-5069
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Country | US
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Telephone | 602-475-6982
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Fax |
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Authorized Official
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Title or Position | OWNER/PROGRAM DIRECTOR
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Name | MISS CANDACE CARTER
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Credential |
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Telephone | 602-475-6982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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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 | 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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