Provider Demographics
NPI:1023370509
Name:CHINASA LLC
Entity Type:Organization
Organization Name:CHINASA LLC
Other - Org Name:ABUNDANT HOMEMAKERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-473-7603
Mailing Address - Street 1:194 LAGUNA CT
Mailing Address - Street 2:ABUNDANT HOMEMAKERS
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7033
Mailing Address - Country:US
Mailing Address - Phone:904-473-7603
Mailing Address - Fax:
Practice Address - Street 1:194 LAGUNA CT
Practice Address - Street 2:ABUNDANT HOMEMAKERS
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7033
Practice Address - Country:US
Practice Address - Phone:904-473-7603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232575251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health