MEDICARE: ABUNDANCE HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	343900000X	Non-emergency Medical Transport (VAN)
3	385H00000X	Respite Care
4	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1760249908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANCE HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	818 E ARDMORE RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7809
Country	:	US
Telephone Number	:	480-479-1716
Fax Number	:

Provider Business Practice Location Address
First Line	:	818 E ARDMORE RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7809
Country	:	US
Telephone Number	:	480-479-1716
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JAZMONE PENNINGTON
Credential	:
Telephone Number	:	480-479-1716

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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Directions to “ABUNDANCE HEALTH CARE LLC ” Practice Location

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