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Organization

ABUNDANT LIVING HEALTHCARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. CASSANDRA CAMILLE DANCY RN (ADMINISTRATOR)
(662) 347-9976
Entity
Organization

Contact information

Practice address
202 GREEN ST, MOUND BAYOU, MS 38762-9762
(662) 741-3354
Mailing address
125 OLD MOUND BAYOU RD, MOUND BAYOU, MS 38762-9591
(662) 741-3354

Taxonomy

Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
00530517
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00530517
MS
Enumeration date
10/08/2012
Last updated
10/08/2012
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