Provider Demographics
NPI:1104362631
Name:ABUNDANT NURSING CARE
Entity Type:Organization
Organization Name:ABUNDANT NURSING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASHELIA
Authorized Official - Middle Name:SHANTA
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-304-6419
Mailing Address - Street 1:445 LAFAYETTE AVE.
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:601-421-2022
Mailing Address - Fax:
Practice Address - Street 1:6230 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7937
Practice Address - Country:US
Practice Address - Phone:601-421-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health