1679094098 NPI number — ABUNDANT HOME HEALTH, LLC

Table of content: (NPI 1679094098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679094098 NPI number — ABUNDANT HOME HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABUNDANT HOME HEALTH, LLC
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:
1679094098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 S 4TH AVE UNIT 5502
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUMA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85366-3558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
747-477-2019
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1332 W 17TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUMA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85364-5308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-477-2019
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARRY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
747-477-2019

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)

  • Identifier: 266778 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".