Abundant Life Treatment Center

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

033097 Issued in NC

Legal business name

ABUNDANT LIFE TREATMENT CENTER

Practice address

108 W Hope Lodge St
Tarboro, NC 27886-2439

Phone

(252) 774-4100

Fax

(252) 774-4100

NPI assigned

Apr 4, 2011

Last updated

Apr 4, 2011By 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

Mrs. Gerenda Latrice Williams

Title

Ceo

Phone

(252) 883-1670

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1467741058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1427",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278861427",
            "telephone_number": "252-774-4100",
            "fax_number": "252-774-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 W HOPE LODGE ST",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278862439",
            "telephone_number": "252-774-4100",
            "fax_number": "252-774-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANT LIFE TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-04",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "GERENDA",
        "authorized_official_middle_name": "LATRICE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-883-1670",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NC",
            "license": "033097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in Tarboro, NC
• Providers in Tarboro, NC by specialty
• Preferred Provider Organization in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; 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.