Organization · NPI-2

Abundant Hearts, LLC

Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities · Stafford, TX

NPI number1639741630

StatusActive

Last updated in NPPESJul 11, 2021

Details

NPI: 1639741630
Entity type: Organization (NPI-2)
Legal business name: Abundant Hearts, LLC
Organization subpart: No
Enumeration date: Jul 11, 2021
Certification date: Jul 11, 2021
Last updated: Jul 11, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	–	–	Yes
251E00000X	Home Health	–	–
251S00000X	Community/Behavioral Health	–	–
320800000X	Community Based Residential Treatment Facility, Mental Illness	–	–

Practice location

5010 Grove West Blvd Unit 2004
Stafford, TX 77477-2624

Phone 832-216-3356

Mailing address

5010 Grove West Blvd Unit 2004
Stafford, TX 77477-2624

Phone 832-216-3356

Authorized official

Derrick Deron Bradley
Owner
8322163356

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