Provider Demographics
NPI:1043470701
Name:1ST ABUNDANT HOME CARE, LLC
Entity Type:Organization
Organization Name:1ST ABUNDANT HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-602-6241
Mailing Address - Street 1:4865 IHLES RD # 14
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5900
Mailing Address - Country:US
Mailing Address - Phone:337-602-6241
Mailing Address - Fax:337-602-6655
Practice Address - Street 1:4865 IHLES RD # 14
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5900
Practice Address - Country:US
Practice Address - Phone:337-602-6241
Practice Address - Fax:337-602-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA15033251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1069868Medicaid