Organization
ABUNDANT HEARTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK DERON BRADLEY (OWNER)
(832) 216-3356
Entity
Organization
Contact information
Practice address
5010 GROVE WEST BLVD UNIT 2004, STAFFORD, TX 77477-2624
(832) 216-3356
Mailing address
5010 GROVE WEST BLVD UNIT 2004, STAFFORD, TX 77477-2624
(832) 216-3356
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/11/2021
Last updated
07/11/2021
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