Provider Demographics
NPI:1275119802
Name:ABUNDANT LIFE SENIOR SERVICES
Entity Type:Organization
Organization Name:ABUNDANT LIFE SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARDAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:318-510-6565
Mailing Address - Street 1:533 SALLY ANN DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6325
Mailing Address - Country:US
Mailing Address - Phone:318-510-6565
Mailing Address - Fax:
Practice Address - Street 1:533 SALLY ANN DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6325
Practice Address - Country:US
Practice Address - Phone:318-510-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare