Organization
ABUNDANT LIVING CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIONDRA N BOHANON (ADMINISTRATOR)
(262) 834-6212
Entity
Organization
Contact information
Practice address
11431 N PORT WASHINGTON RD, STE 290, MEQUON, WI 53092-3462
(262) 834-6212
Mailing address
11431 N PORT WASHINGTON RD, STE 290, MEQUON, WI 53092
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100062989
—
WI
Enumeration date
03/27/2017
Last updated
03/27/2017
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