Provider Demographics
NPI:1508903592
Name:ABUNDANT LIFE HOSPICE, INC.
Entity Type:Organization
Organization Name:ABUNDANT LIFE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:803-807-8440
Mailing Address - Street 1:112 CANTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1202
Mailing Address - Country:US
Mailing Address - Phone:803-807-8440
Mailing Address - Fax:803-477-3312
Practice Address - Street 1:250 S PLEASANTBURG DR STE 126
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2522
Practice Address - Country:US
Practice Address - Phone:864-370-9707
Practice Address - Fax:864-370-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based