Provider Demographics
NPI:1801456322
Name:ABUNDANT GRACE HOSPICE, LLC
Entity type:Organization
Organization Name:ABUNDANT GRACE HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:936-933-4085
Mailing Address - Street 1:1332 E DENMAN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-5701
Mailing Address - Country:US
Mailing Address - Phone:936-632-6721
Mailing Address - Fax:936-632-9826
Practice Address - Street 1:1332 E DENMAN AVE STE 103
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-5701
Practice Address - Country:US
Practice Address - Phone:936-632-6721
Practice Address - Fax:936-632-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty