Organization
ABUNDANT LIFE HOME HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FREDERICK GONZALES (PRESIDENT)
(956) 544-7714
Entity
Organization
Contact information
Practice address
1900 PECAN ST., BROWNSVILLE, TX 78520
(956) 544-7714
(956) 544-1033
Mailing address
1900 PECAN, BROWNSVILLE, TX 78520-8336
(956) 544-7714
(956) 544-1033
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
005661
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000019200
PHC CONTRACT #
TX
05
—
185367302
—
TX
Enumeration date
02/13/2007
Last updated
06/07/2018
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