Provider Demographics
NPI:1841782174
Name:ABUNDANT LIFE HOME CARE LLC
Entity Type:Organization
Organization Name:ABUNDANT LIFE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEMOLA
Authorized Official - Middle Name:WALE
Authorized Official - Last Name:OLOYEDE-ASANIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-418-6447
Mailing Address - Street 1:331 E MAIN ST STE 216
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-5384
Mailing Address - Country:US
Mailing Address - Phone:803-448-2765
Mailing Address - Fax:
Practice Address - Street 1:331 E MAIN ST STE 216
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5384
Practice Address - Country:US
Practice Address - Phone:803-448-2765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-0842253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCIHCP-0842OtherPRIVATE
SCIHCP-0842Medicaid