Provider Demographics
NPI:1578054011
Name:ABUNDANT LIFE CARE CENTER L.L.C.
Entity Type:Organization
Organization Name:ABUNDANT LIFE CARE CENTER L.L.C.
Other - Org Name:ABUNDANT LIFE CARE CENTER L.L.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-624-3270
Mailing Address - Street 1:826 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-6677
Mailing Address - Country:US
Mailing Address - Phone:386-624-3270
Mailing Address - Fax:
Practice Address - Street 1:826 MARGARET ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-6677
Practice Address - Country:US
Practice Address - Phone:386-624-3270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care