Organization
ABUNDANT LOVE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHAWANA ANTOINETTE ROACH (EXECUTIVE DIRECTOR)
(757) 477-0424
Entity
Organization
Contact information
Practice address
10424 WALTON LAKE RD, DISPUTANTA, VA 23842-4703
(757) 477-0424
Mailing address
10424 WALTON LAKE RD, DISPUTANTA, VA 23842-4703
(757) 477-0424
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
2452-01-001
VA
Other
Enumeration date
07/23/2018
Last updated
07/23/2018
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