Provider Demographics
NPI:1386786234
Name:ABUNDANT LIFE HOME HEALTH, INC.
Entity type:Organization
Organization Name:ABUNDANT LIFE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-544-7714
Mailing Address - Street 1:1900 PECAN
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8336
Mailing Address - Country:US
Mailing Address - Phone:956-544-7714
Mailing Address - Fax:956-544-1033
Practice Address - Street 1:1900 PECAN ST.
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520
Practice Address - Country:US
Practice Address - Phone:956-544-7714
Practice Address - Fax:956-544-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005661251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185367302Medicaid
TX000019200OtherPHC CONTRACT #
TX000019200OtherPHC CONTRACT #
TX001000792OtherCBA CONTRACT #