1659935823 NPI number — ABUNDANT GRACE HOME HEALTH SERVICES, INC.

Table of content: (NPI 1659935823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659935823 NPI number — ABUNDANT GRACE HOME HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABUNDANT GRACE HOME HEALTH SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659935823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/22/2023
NPI Reactivation Date:
06/19/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 E FOOTHILL BLVD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIMAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91773-1254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-472-2301
Provider Business Mailing Address Fax Number:
888-254-3703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 E FOOTHILL BLVD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIMAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91773-1254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-472-2301
Provider Business Practice Location Address Fax Number:
888-254-3703
Provider Enumeration Date:
04/23/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ABAGON
Authorized Official First Name:
ARLENE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
RN
Authorized Official Telephone Number:
909-868-8620

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)