# ABUNDANT CHRISTIAN LIVING COMMUNITY LLC

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

## Provider details

- **NPI number:** 1902491178
- **Authorized official:** MR. JIMMY R. LEWIS (CHIEF MANAGER)
- **Authorized official phone:** (423) 975-5455

## Contact information

- **Practice address:** 2012 SHERWOOD DR, JOHNSON CITY, TN 37601-3238
- **Practice address phone:** (423) 232-8200
- **Practice address fax:** (423) 232-8240
- **Mailing address:** 2020 NORTHPARK DR STE 2D, JOHNSON CITY, TN 37604-3127
- **Mailing address phone:** (423) 975-5455
- **Mailing address fax:** (423) 390-0743

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | — |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | — |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/09/2021
- **Last updated:** 03/10/2021