Provider Demographics
NPI:1407037856
Name:ABUNDANT LIFE MINISTRY
Entity Type:Organization
Organization Name:ABUNDANT LIFE MINISTRY
Other - Org Name:ABUNDANT LIFE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:RYSHKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:414-257-4350
Mailing Address - Street 1:1904 E BELLEVIEW PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3901
Mailing Address - Country:US
Mailing Address - Phone:414-962-3200
Mailing Address - Fax:414-962-3302
Practice Address - Street 1:1904 E BELLEVIEW PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-3901
Practice Address - Country:US
Practice Address - Phone:414-962-3200
Practice Address - Fax:414-962-3302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABUNDANT LIFE MINISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances