Organization
ABUNDANT CHRISTIAN LIVING COMMUNITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIMMY R. LEWIS (CHIEF MANAGER)
(423) 975-5455
Entity
Organization
Contact information
Practice address
2012 SHERWOOD DR, JOHNSON CITY, TN 37601-3238
(423) 232-8200
(423) 232-8240
Mailing address
2020 NORTHPARK DR STE 2D, JOHNSON CITY, TN 37604-3127
(423) 975-5455
(423) 390-0743
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
03/09/2021
Last updated
03/10/2021
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