Provider Demographics
NPI:1568030518
Name:ABUNDANCE OF LOVE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:ABUNDANCE OF LOVE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:ALM
Authorized Official - Phone:240-329-7714
Mailing Address - Street 1:2715 CYLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5319
Mailing Address - Country:US
Mailing Address - Phone:240-329-7714
Mailing Address - Fax:
Practice Address - Street 1:2715 CYLBURN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5319
Practice Address - Country:US
Practice Address - Phone:240-329-7714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility