MEDICARE: ABUNDANCE MEDICAL SOLUTIONS 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1740564541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANCE MEDICAL SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	7404 TORMES
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6783
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7404 TORMES
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6783
Country	:	US
Telephone Number	:	469-265-6701
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. KENYA K PHILIPS
Credential	:	RN
Telephone Number	:	469-265-6701

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	09/29/2011

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