Provider Demographics
NPI:1740564541
Name:ABUNDANCE MEDICAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:ABUNDANCE MEDICAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PHILIPS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:469-265-6701
Mailing Address - Street 1:7404 TORMES
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6783
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7404 TORMES
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6783
Practice Address - Country:US
Practice Address - Phone:469-265-6701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health