Provider Demographics
NPI:1851633036
Name:ABUNDANCE HOME CARE, INC.
Entity Type:Organization
Organization Name:ABUNDANCE HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALDRICH
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:763-315-1050
Mailing Address - Street 1:3030 HARBOR LN N
Mailing Address - Street 2:SUITE #124
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5110
Mailing Address - Country:US
Mailing Address - Phone:763-315-1050
Mailing Address - Fax:763-315-1090
Practice Address - Street 1:3030 HARBOR LN N
Practice Address - Street 2:SUITE #124
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5110
Practice Address - Country:US
Practice Address - Phone:763-315-1050
Practice Address - Fax:763-315-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29273251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health