Provider Demographics
NPI:1831335827
Name:ABUNDANT HEALTH, INC.
Entity type:Organization
Organization Name:ABUNDANT HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-332-1500
Mailing Address - Street 1:12336 W LAYTON AVE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-3000
Mailing Address - Country:US
Mailing Address - Phone:262-332-1500
Mailing Address - Fax:
Practice Address - Street 1:12336 W LAYTON AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3000
Practice Address - Country:US
Practice Address - Phone:262-332-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health