Provider Demographics
NPI:1821645490
Name:BE ABUNDANT INC
Entity Type:Organization
Organization Name:BE ABUNDANT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-893-2275
Mailing Address - Street 1:2626 SE 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1425
Mailing Address - Country:US
Mailing Address - Phone:503-893-2275
Mailing Address - Fax:
Practice Address - Street 1:2405 SE 11TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5307
Practice Address - Country:US
Practice Address - Phone:503-893-2275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty