Provider Demographics
NPI:1447636725
Name:LOVE ABUNDANTLY HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:LOVE ABUNDANTLY HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-474-8743
Mailing Address - Street 1:3637 MONTICELLO WAY
Mailing Address - Street 2:
Mailing Address - City:HEARTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75126-2556
Mailing Address - Country:US
Mailing Address - Phone:469-446-8002
Mailing Address - Fax:
Practice Address - Street 1:3637 MONTICELLO WAY
Practice Address - Street 2:
Practice Address - City:HEARTLAND
Practice Address - State:TX
Practice Address - Zip Code:75126-2556
Practice Address - Country:US
Practice Address - Phone:469-446-8002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
TX0172093747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty