Basic Information
| Provider Information | |||||||||
| NPI: | 1164522975 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABUNDANT HOME HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 AVENUE J | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760065867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176333152 | ||||||||
| FaxNumber: | 8173942587 | ||||||||
| Practice Location | |||||||||
| Address1: | 2221 AVENUE J | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760065867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176333152 | ||||||||
| FaxNumber: | 8173942587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | SANTIAGO | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/ OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6945565955 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N | Agencies | Home Health | 251E00000X | 009124 | TX | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 193904301 | 05 | TX | MEDICAID | H0HH541H01 | 01 | TX | BCBS | OTHER |