Provider Demographics
NPI:1013221548
Name:ABUNDANT LIFE A&E SERVICES,LLP
Entity Type:Organization
Organization Name:ABUNDANT LIFE A&E SERVICES,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-261-9893
Mailing Address - Street 1:PO BOX 1682
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-1682
Mailing Address - Country:US
Mailing Address - Phone:336-261-9893
Mailing Address - Fax:336-358-6417
Practice Address - Street 1:427 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-2929
Practice Address - Country:US
Practice Address - Phone:336-261-9893
Practice Address - Fax:336-358-6417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)