Provider Demographics
NPI:1659935823
Name:ABUNDANT GRACE HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ABUNDANT GRACE HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:ABAGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-868-8620
Mailing Address - Street 1:510 E FOOTHILL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1254
Mailing Address - Country:US
Mailing Address - Phone:844-472-2301
Mailing Address - Fax:888-254-3703
Practice Address - Street 1:510 E FOOTHILL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1254
Practice Address - Country:US
Practice Address - Phone:844-472-2301
Practice Address - Fax:888-254-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2023-06-19
Deactivation Date:2023-05-22
Deactivation Code:
Reactivation Date:2023-06-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health