MEDICARE: ABUNDANT HEART HOME CARE LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1306475637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT HEART HOME CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 841501
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-0138
Country	:	US
Telephone Number	:	281-819-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 WHITMAN DR
Second Line	:
City	:	IOWA COLONY
State	:	TX
Zip	:	77583-1210
Country	:	US
Telephone Number	:	281-819-1888
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KATHERINE NUNN
Credential	:
Telephone Number	:	281-819-1888

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	05/26/2020

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