Provider Demographics
NPI:1164306429
Name:ABUNDANT GRACE SERVICES
Entity type:Organization
Organization Name:ABUNDANT GRACE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-323-4243
Mailing Address - Street 1:3223 W LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-1439
Mailing Address - Country:US
Mailing Address - Phone:414-323-4243
Mailing Address - Fax:
Practice Address - Street 1:3223 W LLOYD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1439
Practice Address - Country:US
Practice Address - Phone:414-323-4243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-31
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services