MEDICARE: ABUNDANCE OF CARE HOME SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	164W00000X	Licensed Practical Nurse
2	251J00000X	Nursing Care Agency
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1447827449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANCE OF CARE HOME SERVICES LLC

Provider Business Mailing Address
First Line	:	3596 NORMANDY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-5243
Country	:	US
Telephone Number	:	707-755-6289
Fax Number	:

Provider Business Practice Location Address
First Line	:	3596 NORMANDY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-5243
Country	:	US
Telephone Number	:	707-755-6289
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARMEN BRUCE
Credential	:	LPN
Telephone Number	:	707-755-6289

Provider Enumeration Date	:	06/08/2021
Last Update Date	:	06/08/2021

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