1356308886 NPI number — ABUNDANT HEALTH CARE INC

Table of content: (NPI 1356308886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356308886 NPI number — ABUNDANT HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABUNDANT HEALTH CARE 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:
6
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:
1356308886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 E NOLANA AVE
Provider Second Line Business Mailing Address:
SUITE B &C
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-631-0012
Provider Business Mailing Address Fax Number:
956-631-0054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 E NOLANA AVE
Provider Second Line Business Practice Location Address:
SUITE B &C
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-631-0012
Provider Business Practice Location Address Fax Number:
956-631-0054
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUTLEDGE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
RN ADMINISTRATOR
Authorized Official Telephone Number:
956-631-0012

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  007025 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: 007268 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000110200 . This is a "PRIMARY HOME CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 024347901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000959000 . This is a "COMMUNITYBASED ALTERNATIV" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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