Provider Demographics
NPI:1457950776
Name:ABUNDANT GRACE SENIOR CARE, LLC
Entity Type:Organization
Organization Name:ABUNDANT GRACE SENIOR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-275-2888
Mailing Address - Street 1:10650 REAGAN ST UNIT 1531
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-8882
Mailing Address - Country:US
Mailing Address - Phone:562-275-2888
Mailing Address - Fax:
Practice Address - Street 1:3830 W AGUA FRIA DR
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86413-9309
Practice Address - Country:US
Practice Address - Phone:562-275-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care