Organization
ABUNDANT LIFE IN-HOME SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAKESHA NANCE RN (ADMINISTRATIVE DIRECTOR/OWNER)
(704) 649-9904
Entity
Organization
Contact information
Practice address
301 MCCULLOUGH DR STE 400, CHARLOTTE, NC 28262-1336
(704) 649-9904
Mailing address
10119 FIELDSTONE CT, CHARLOTTE, NC 28269-2007
(704) 649-9904
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HC5727
DIVISION OF HEALTH SERVICE REGULATION
NC
Enumeration date
10/08/2020
Last updated
12/10/2020
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