Provider Demographics
NPI:1952176752
Name:ABUNDANT BEGINNINGS RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:ABUNDANT BEGINNINGS RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-475-6982
Mailing Address - Street 1:6628 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-5069
Mailing Address - Country:US
Mailing Address - Phone:602-475-6982
Mailing Address - Fax:
Practice Address - Street 1:4207 W MISSION LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3256
Practice Address - Country:US
Practice Address - Phone:602-475-6982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation