Provider Demographics
NPI:1497076038
Name:ABUNDANT LIFE FAMILY CENTER
Entity Type:Organization
Organization Name:ABUNDANT LIFE FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-548-9399
Mailing Address - Street 1:PO BOX 714
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06142-0714
Mailing Address - Country:US
Mailing Address - Phone:860-548-9399
Mailing Address - Fax:860-548-9819
Practice Address - Street 1:255 BARBOUR ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1705
Practice Address - Country:US
Practice Address - Phone:860-548-9399
Practice Address - Fax:860-548-9819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health