Provider Demographics
NPI:1790516920
Name:ABUNDANT LIFE COMMUNITY SUPPORT SERVICES
Entity type:Organization
Organization Name:ABUNDANT LIFE COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:HS-BCP
Authorized Official - Phone:719-597-5110
Mailing Address - Street 1:76 S SIERRA MADRE ST STE L
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3399
Mailing Address - Country:US
Mailing Address - Phone:719-597-5110
Mailing Address - Fax:
Practice Address - Street 1:76 S SIERRA MADRE ST STE L
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3399
Practice Address - Country:US
Practice Address - Phone:719-597-5110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)