Provider Demographics
NPI:1407324411
Name:ABUNDANT CARE SERVICES
Entity Type:Organization
Organization Name:ABUNDANT CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKOCHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-578-0348
Mailing Address - Street 1:2805 FOSTER AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-5341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2805 FOSTER AVE STE 206
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-5341
Practice Address - Country:US
Practice Address - Phone:615-578-0348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities