Provider Demographics
NPI:1659989457
Name:ABUDANT LIVING HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ABUDANT LIVING HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HIETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, RNFA
Authorized Official - Phone:573-579-4899
Mailing Address - Street 1:3151 PARK PLACE DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3151 PARK PLACE DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6378
Practice Address - Country:US
Practice Address - Phone:573-579-4899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child