Provider Demographics
NPI: | 1437910890 |
---|---|
Name: | ABUNDANT GRACE TOTAL CARE |
Entity Type: | Organization |
Organization Name: | ABUNDANT GRACE TOTAL CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/PRESIDENT |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | TOLONDONAKIA |
Authorized Official - Middle Name: | RACHELLE |
Authorized Official - Last Name: | DANIELS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OWNER |
Authorized Official - Phone: | 251-230-1941 |
Mailing Address - Street 1: | 822 LOVELACE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | BREWTON |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 36426-1718 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 251-230-1941 |
Mailing Address - Fax: | 800-730-0995 |
Practice Address - Street 1: | 822 LOVELACE AVE |
Practice Address - Street 2: | |
Practice Address - City: | BREWTON |
Practice Address - State: | AL |
Practice Address - Zip Code: | 36426-1718 |
Practice Address - Country: | US |
Practice Address - Phone: | 251-230-1941 |
Practice Address - Fax: | 800-730-0995 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ABUNDANT GRACE TOTAL CARE |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2024-01-22 |
Last Update Date: | 2024-02-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 374U00000X | Nursing Service Related Providers | Home Health Aide | Group - Single Specialty |