Organization
ABUNDANT LIVING CARE ADULT FAMILY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIONDRA N BOHANON (ADMINISTRATOR)
(414) 403-9947
Entity
Organization
Contact information
Practice address
2721 N 18TH ST, MILWAUKEE, WI 53206-2135
(414) 930-0138
(262) 546-0749
Mailing address
PO BOX 18075, MILWAUKEE, WI 53218-0075
(414) 403-9947
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
01/22/2019
Last updated
01/22/2019
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