Provider Demographics
NPI:1245704105
Name:ABUNDANTLY BLESSED HOME CARE LLC
Entity type:Organization
Organization Name:ABUNDANTLY BLESSED HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW-WRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-867-9564
Mailing Address - Street 1:1319 S 58TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-4501
Mailing Address - Country:US
Mailing Address - Phone:215-867-9564
Mailing Address - Fax:
Practice Address - Street 1:1319 S 58TH ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19143-4501
Practice Address - Country:US
Practice Address - Phone:215-867-9564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care