Provider Demographics
NPI:1265252811
Name:ABUNDANCE CARE RESIDENTIAL ASSISTED LIVING
Entity type:Organization
Organization Name:ABUNDANCE CARE RESIDENTIAL ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-861-0982
Mailing Address - Street 1:1210 S GLEBE RD UNIT 40592
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-0283
Mailing Address - Country:US
Mailing Address - Phone:703-861-0982
Mailing Address - Fax:
Practice Address - Street 1:12619 KAVANAUGH LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-2816
Practice Address - Country:US
Practice Address - Phone:301-262-1657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility