Provider Demographics
NPI:1598580730
Name:ABUNDANTLY BLESSED LLL
Entity type:Organization
Organization Name:ABUNDANTLY BLESSED LLL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAW-WRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-906-0911
Mailing Address - Street 1:2910 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-3236
Mailing Address - Country:US
Mailing Address - Phone:215-375-3939
Mailing Address - Fax:215-475-6097
Practice Address - Street 1:6650 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4809
Practice Address - Country:US
Practice Address - Phone:843-268-8364
Practice Address - Fax:843-268-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty