# ABUNDANT LIVING GROUP HOME, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** New Abundant Living I
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164616835
- **Authorized official:** MRS. JANICE ANIECE TIMPSON (OWNER)
- **Authorized official phone:** (336) 623-7669

## Contact information

- **Practice address:** 438 CREEKRIDGE DR, EDEN, NC 27288-2817
- **Practice address phone:** (336) 623-7669
- **Practice address fax:** (336) 623-1139
- **Mailing address:** 438 CREEKRIDGE DR, EDEN, NC 27288-2817
- **Mailing address phone:** (336) 623-7669
- **Mailing address fax:** (336) 623-1139

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-079-076 | NC | Yes |

## Other

- **Enumeration date:** 09/05/2007
- **Last updated:** 09/05/2007