Provider Demographics
NPI:1588023402
Name:ABUNDANT HEALTH, INC.
Entity Type:Organization
Organization Name:ABUNDANT HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-708-1738
Mailing Address - Street 1:1901 MANHATTAN BLVD
Mailing Address - Street 2:BUILDING F, SUITE 204
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-3582
Mailing Address - Country:US
Mailing Address - Phone:504-708-1738
Mailing Address - Fax:504-603-2662
Practice Address - Street 1:1901 MANHATTAN BLVD
Practice Address - Street 2:BUILDING F, SUITE 204
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-3582
Practice Address - Country:US
Practice Address - Phone:504-708-1738
Practice Address - Fax:504-603-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1265748693Medicaid