Organization · NPI-2

Abundant Life Care Clinic LLC

Nurse Practitioner, Family · Catonsville, MD

NPI number1487388930

StatusActive

Last updated in NPPESJul 24, 2023

Details

NPI: 1487388930
Entity type: Organization (NPI-2)
Legal business name: Abundant Life Care Clinic LLC
Organization subpart: No
Enumeration date: Jul 11, 2022
Certification date: Jul 24, 2023
Last updated: Jul 24, 2023

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363LF0000X	Nurse Practitioner, Family	–	–	Yes
261QM1300X	Clinic/Center, Multi-Specialty	–	–
251E00000X	Home Health	–	–
253Z00000X	In Home Supportive Care	–	–
261Q00000X	Clinic/Center	–	–

Practice location

516 N Rolling Rd Ste 203
Catonsville, MD 21228-4187

Phone 216-925-9786

Mailing address

4317 Jordan Way
Perry Hall, MD 21128-9859

Authorized official

Patience M Chia
Owner
2169259786

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