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?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty