Organization Name: | ABUNDANT LIFE THERAPEUTIC SERVICES LLC |
NPI Number: | 1285076067 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MELVIN L ANDERSON (EXECUTIVE DIRECTOR) |
Mailing Address: | 645 Church St. Suite 104c Norfolk |
State: | VA US |
Postal Code: | 23510 |
Phone Number: | 7576160657 |
Fax Number: | 7575339369 |
NPI Enumeration Date: | 07/22/2013 |
NPI Last Update Date: | 06/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320600000X |
License Number: | 2154 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |