# ABUNDANT GRACE HOME CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073182424
- **Authorized official:** KIERRA DEGALE YOUNGBLOOD RN (OWNER/CEO/DON)
- **Authorized official phone:** (318) 773-4845

## Contact information

- **Practice address:** 9051 MANSFIELD RD STE B7, SHREVEPORT, LA 71118-2666
- **Practice address phone:** (318) 773-4845
- **Practice address fax:** (318) 716-1024
- **Mailing address:** 1651 E 70TH ST \# 264, SHREVEPORT, LA 71105-5115
- **Mailing address phone:** (318) 773-4845
- **Mailing address fax:** (318) 716-1024

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 06/21/2021
- **Last updated:** 06/21/2021