Abundant Life Home Health Agency,LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

299993080 Issued in FL

Legal business name

ABUNDANT LIFE HOME HEALTH AGENCY,LLC

Practice address

6601 Memorial Hwy Ste 106
Tampa, FL 33615-4501

Phone

(727) 286-8916

Fax

(727) 724-1201

NPI assigned

Mar 4, 2009

Last updated

May 10, 2023By 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

Traci S Brissett, RN

Title

Director of Nursing

Phone

(727) 286-8916

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205076155. Details of each certification follow.

• CCN 683133 Home health agency · Active · Details

Home health agency certification: CCN 683133

Legal name

ABUNDANT LIFE HOME HEALTH AGENCY,LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Feb 10, 2014

Last certification

Jan 23, 2020

Ownership / control type

Non-Profit

Organization structure

LLCProprietary

Enrollment address

28050 US Highway 19N
Ste 205
Clearwater, FL 33761-2627

Listed as

Abundant Life Home Health Agency LLCCCN 683133 · All quality measures

Ownership

Non-Profit

Certified

Feb 10, 2014

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Abundant Life Home Health Agencyllc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Abundant Life Home Health Agency,LLC

  • Home Health Agency
  • Tampa, FL
  • NPI 1609523604
  NPD tax ID

Locations

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Avian Home Health LLC

  • Home Health Agency
  • Tampa, FL
  • NPI 1275957987

  Emily Schnaper Trust, James C. Hays Revocable Trust, Theodore Roosevelt Progressive Trust, Tin Goose Health Investors LLC

  CMS ownership
• Focused Home Health Agency, Inc.

  • Home Health Agency
  • Hollywood, FL
  • NPI 1194283820

  Emily Schnaper Trust, James C. Hays Revocable Trust, Theodore Roosevelt Progressive Trust, Tin Goose Health Investors LLC

  CMS ownership
• Sun Care LLC

  dba Palm Beach Home Health Agency

  • Home Health Agency
  • Boca Raton, FL
  • NPI 1710209887

  Emily Schnaper Trust, James C. Hays Revocable Trust, Theodore Roosevelt Progressive Trust, Tin Goose Health Investors LLC

  CMS ownership

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

{
    "created_epoch": "1236124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683676800000",
    "number": "1205076155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28050 US HIGHWAY 19 N STE 205",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337612627",
            "telephone_number": "727-286-8916",
            "fax_number": "727-724-1201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 MEMORIAL HWY STE 106",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336154501",
            "telephone_number": "727-286-8916",
            "fax_number": "727-724-1201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "28050 US Highway 19 N",
            "address_2": "SUITE 205",
            "address_purpose": "LOCATION",
            "city": "Clearwater",
            "state": "FL",
            "postal_code": "337612634",
            "country_code": "US",
            "telephone_number": "727-286-8916",
            "fax_number": "727-724-1201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "28050 US Highway 19 N Ste 205",
            "address_purpose": "LOCATION",
            "city": "Clearwater",
            "state": "FL",
            "postal_code": "337612627",
            "country_code": "US",
            "telephone_number": "727-286-8916",
            "fax_number": "727-724-1201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ABUNDANT LIFE HOME HEALTH AGENCY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-04",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A",
        "authorized_official_last_name": "BRISSETT",
        "authorized_official_first_name": "TRACI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DIRECTOR OF NURSING",
        "authorized_official_telephone_number": "727-286-8916",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": "299993080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111860500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "68-3133",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA LICENSE",
            "identifier": "299994461",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.alhha.com",
            "affiliation": "N",
            "address_1": "28050 US Highway 19 N Ste 205",
            "city": "Clearwater",
            "state": "FL",
            "country_code": "US",
            "postal_code": "337612627",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hazem Louae Abugrara, M.D.
• Husam Aldean Mahdi Abuhayyeh, M.D.
• Ziad Abuhelwa, MD
• Amal Hani Abukhdeir, NP-C
• Ashraf Abulhaija, APRN
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• Home Health Agency in Tampa, FL
• Providers in Tampa, FL by specialty
• Home Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.