Provider Demographics
NPI:1215709480
Name:ABUNDANT LIVING LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:ABUNDANT LIVING LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-629-0696
Mailing Address - Street 1:8821 WINTERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4174
Mailing Address - Country:US
Mailing Address - Phone:443-629-0696
Mailing Address - Fax:
Practice Address - Street 1:8821 WINTERBROOK RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4174
Practice Address - Country:US
Practice Address - Phone:443-629-0696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child