Provider Demographics
NPI:1013215235
Name:ABUNDANT LIVING SUPPORTIVE SERVICES
Entity Type:Organization
Organization Name:ABUNDANT LIVING SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DEBROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-487-7612
Mailing Address - Street 1:4555 W 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80030-5759
Mailing Address - Country:US
Mailing Address - Phone:303-487-7612
Mailing Address - Fax:303-487-7612
Practice Address - Street 1:223 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3336
Practice Address - Country:US
Practice Address - Phone:303-487-7612
Practice Address - Fax:303-487-7612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care