Provider Demographics
NPI:1760761977
Name:ABUNDANT LIFE HOME CARE INC.
Entity Type:Organization
Organization Name:ABUNDANT LIFE HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTIN-PREVOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-380-3903
Mailing Address - Street 1:1905 WOODS DR STE 223
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2240
Mailing Address - Country:US
Mailing Address - Phone:937-380-3903
Mailing Address - Fax:
Practice Address - Street 1:1905 WOODS DR STE 223
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2240
Practice Address - Country:US
Practice Address - Phone:937-380-3903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health