Provider Demographics
NPI:1073278339
Name:ABUNDANCE OF GENERATIONAL HEALTH CARE LLC
Entity Type:Organization
Organization Name:ABUNDANCE OF GENERATIONAL HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TELENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-400-1717
Mailing Address - Street 1:21001 WATERTOWN RD STE 303
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1818
Mailing Address - Country:US
Mailing Address - Phone:414-614-0666
Mailing Address - Fax:
Practice Address - Street 1:21001 WATERTOWN RD STE 303
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1818
Practice Address - Country:US
Practice Address - Phone:414-614-0666
Practice Address - Fax:262-264-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health