Provider Demographics
NPI:1902057862
Name:ABUNDANT LIFE HOSPICE, LLC.
Entity Type:Organization
Organization Name:ABUNDANT LIFE HOSPICE, LLC.
Other - Org Name:ABUNDANT LIFE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-845-0191
Mailing Address - Street 1:2612 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-4302
Mailing Address - Country:US
Mailing Address - Phone:434-845-0191
Mailing Address - Fax:434-386-0606
Practice Address - Street 1:2612 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-4302
Practice Address - Country:US
Practice Address - Phone:434-845-0191
Practice Address - Fax:434-386-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001185060311ZA0620X, 314000000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility