NPIMap

Organization Active NPI

Abundant Life Agency

  • Skilled Nursing Facility
  • Brooklyn, NY
National Provider Identifier
1972832590
Registry record updated Dec 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
9108L001 Issued in NY
Legal business name
ABUNDANT LIFE AGENCY
Practice address
827 Clarkson Ave
Brooklyn, NY 11203-2256
Phone
(718) 735-7151
Fax
(718) 735-7141
NPI assigned
Dec 10, 2009
Last updated
Dec 10, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2009

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

Authorized official

Name
Mr. Keston Jason John
Title
Program Coordinator
Phone
(718) 735-7151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 9108L001 NY Primary

Addresses

Primary practice location

827 Clarkson Ave
Brooklyn, NY 11203-2256

Mailing address

827 Clarkson Ave
Brooklyn, NY 11203-2256
Phone (718) 735-7151

National Provider Directory

National Provider Directory
Tax ID family
Abundant Life Agency4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1260403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260403200000",
    "number": "1972832590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "827 CLARKSON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032256",
            "telephone_number": "718-735-7151",
            "fax_number": "718-735-7141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 CLARKSON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032256",
            "telephone_number": "718-735-7151",
            "fax_number": "718-735-7141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANT LIFE AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-10",
        "last_updated": "2009-12-10",
        "status": "A",
        "authorized_official_last_name": "JOHN",
        "authorized_official_first_name": "KESTON",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "PROGRAM COORDINATOR",
        "authorized_official_telephone_number": "718-735-7151",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "9108L001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2009; 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.