Provider Demographics
NPI:1124191614
Name:ABUNDANT LIFE CENTER II, LLC
Entity Type:Organization
Organization Name:ABUNDANT LIFE CENTER II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-651-7972
Mailing Address - Street 1:1313 PLEASANT CREEK CT
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-6841
Mailing Address - Country:US
Mailing Address - Phone:804-651-7972
Mailing Address - Fax:804-530-0195
Practice Address - Street 1:9831 KEVKEN DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23237-4058
Practice Address - Country:US
Practice Address - Phone:804-748-3368
Practice Address - Fax:804-748-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA895-14-00322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children