Provider Demographics
NPI:1659149821
Name:ABUNDANTLY FULL OF LOVE
Entity Type:Organization
Organization Name:ABUNDANTLY FULL OF LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RASHADA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAUSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-682-1556
Mailing Address - Street 1:15400 LAUDER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-2629
Mailing Address - Country:US
Mailing Address - Phone:313-682-1556
Mailing Address - Fax:
Practice Address - Street 1:15400 LAUDER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-2629
Practice Address - Country:US
Practice Address - Phone:313-682-1556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty