Provider Demographics
NPI:1992446850
Name:ABUNDANTLY LIVING HOME CARE
Entity type:Organization
Organization Name:ABUNDANTLY LIVING HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-955-0967
Mailing Address - Street 1:11200 BROADWAY ST STE 2743
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9787
Mailing Address - Country:US
Mailing Address - Phone:713-955-0967
Mailing Address - Fax:
Practice Address - Street 1:11200 BROADWAY ST STE 2743
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9787
Practice Address - Country:US
Practice Address - Phone:713-955-0967
Practice Address - Fax:281-262-3122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAM SPADE COFFEE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care