Provider Demographics
NPI:1164522975
Name:ABUNDANT HOME HEALTH, LLC
Entity Type:Organization
Organization Name:ABUNDANT HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:694-556-5955
Mailing Address - Street 1:2221 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-5867
Mailing Address - Country:US
Mailing Address - Phone:817-633-3152
Mailing Address - Fax:817-394-2587
Practice Address - Street 1:2221 AVENUE J
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-5867
Practice Address - Country:US
Practice Address - Phone:817-633-3152
Practice Address - Fax:817-394-2587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009124251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193904301Medicaid
TXH0HH541H01OtherBCBS