Provider Demographics
NPI:1083251599
Name:LIFE OF ABUNDANCE, LLC
Entity Type:Organization
Organization Name:LIFE OF ABUNDANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-310-5259
Mailing Address - Street 1:3725 DEARING DOWNS DRIVE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405
Mailing Address - Country:US
Mailing Address - Phone:205-310-5259
Mailing Address - Fax:
Practice Address - Street 1:22640 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:MC CALLA
Practice Address - State:AL
Practice Address - Zip Code:35111-2652
Practice Address - Country:US
Practice Address - Phone:205-310-5259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities