Provider Demographics
NPI:1689753568
Name:ABUNDANT LIVING ADULT DAY SERVICES, INC.
Entity Type:Organization
Organization Name:ABUNDANT LIVING ADULT DAY SERVICES, INC.
Other - Org Name:TRINITY LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-754-8222
Mailing Address - Street 1:PO BOX 947
Mailing Address - Street 2:1416 S MARTIN LUTHER KING JR.
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28145-0947
Mailing Address - Country:US
Mailing Address - Phone:704-637-2870
Mailing Address - Fax:704-637-2950
Practice Address - Street 1:1416 S MARTIN LUTHER KING JR AVE STE A
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-637-3940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SERVICE OF THE AGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3408548261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408548Medicaid