MEDICARE: ABUNDANCE LIFE HEALTHCARE 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	:	1891552667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANCE LIFE HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	901 ELMWOOD AVE
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2028
Country	:	US
Telephone Number	:	803-466-6696
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 ELMWOOD AVE
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2028
Country	:	US
Telephone Number	:	803-466-6696
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VERNISHIA ROBINSON
Credential	:	DC
Telephone Number	:	803-466-6696

Provider Enumeration Date	:	02/28/2024
Last Update Date	:	02/28/2024

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