Provider Demographics
NPI:1366081812
Name:ABUNDANT CARE SERVICES LLC
Entity type:Organization
Organization Name:ABUNDANT CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEZBORN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-644-7284
Mailing Address - Street 1:297 LCR 114
Mailing Address - Street 2:
Mailing Address - City:AXTELL
Mailing Address - State:TX
Mailing Address - Zip Code:76624-1333
Mailing Address - Country:US
Mailing Address - Phone:254-644-7284
Mailing Address - Fax:
Practice Address - Street 1:1100 MAXFIELD ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-2967
Practice Address - Country:US
Practice Address - Phone:254-644-7284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities