Provider Demographics
NPI:1447651997
Name:ABUNDANT LOVE
Entity type:Organization
Organization Name:ABUNDANT LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:KELLIE
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:414-745-2252
Mailing Address - Street 1:1720 W FLORIST AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3800
Mailing Address - Country:US
Mailing Address - Phone:414-745-2252
Mailing Address - Fax:
Practice Address - Street 1:15000 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4540
Practice Address - Country:US
Practice Address - Phone:414-745-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management