Abundant Life Center II, LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

895-14-00 Issued in VA

Legal business name

ABUNDANT LIFE CENTER II, LLC

Practice address

9831 Kevken Dr
Richmond, VA 23237-4058

Phone

(804) 748-3368

Fax

(804) 748-3662

NPI assigned

Nov 15, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Rodney Mark Williams

Title

Executive Director

Phone

(804) 651-7972

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124191614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 PLEASANT CREEK CT",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238346841",
            "telephone_number": "804-651-7972",
            "fax_number": "804-530-0195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9831 KEVKEN DR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232374058",
            "telephone_number": "804-748-3368",
            "fax_number": "804-748-3662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANT LIFE CENTER II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "804-651-7972",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "VA",
            "license": "895-14-00",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Richmond, VA
• Providers in Richmond, VA by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.