MEDICARE: ABUNDANT HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	24898	VA

General Provider Information

NPI Number	:	1215294939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT HOME CARE

Provider Business Mailing Address
First Line	:	4643 STONEBRIDGE LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-7278
Country	:	US
Telephone Number	:	757-277-5979
Fax Number	:

Provider Business Practice Location Address
First Line	:	4643 STONEBRIDGE LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-7278
Country	:	US
Telephone Number	:	757-277-5979
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTY D SMITH
Credential	:
Telephone Number	:	757-277-5979

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	04/19/2012

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