Provider Demographics
NPI:1578879987
Name:ABUNDANT CARE ASSISTED LIVING
Entity Type:Organization
Organization Name:ABUNDANT CARE ASSISTED LIVING
Other - Org Name:NURSING
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:301-655-0244
Mailing Address - Street 1:7201 GLEN PINE ST
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9466
Mailing Address - Country:US
Mailing Address - Phone:301-655-0244
Mailing Address - Fax:
Practice Address - Street 1:6209 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2149
Practice Address - Country:US
Practice Address - Phone:301-655-0244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNO. 16AL0965-AOtherDHMH OFFICE OF HEALTH CARE QUALITY