Abundant Grace Health Services LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

012218-388 Issued in DC

Legal business name

ABUNDANT GRACE HEALTH SERVICES LLC

Practice address

4645 Nannie Helen Burroughs Ave NE
Washington, DC 20019-3622

Phone

(240) 468-6009

NPI assigned

Jul 31, 2018

Last updated

Jul 31, 2018By 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

Jeanne Sanja Johnson, NURSE

Title

Ceo

Phone

(240) 468-6009

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532995200000",
    "number": "1982182150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4645 NANNIE HELEN BURROUGHS AVE NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200193622",
            "telephone_number": "240-468-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4645 NANNIE HELEN BURROUGHS AVE NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200193622",
            "telephone_number": "240-468-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANT GRACE HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-31",
        "last_updated": "2018-07-31",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_middle_name": "SANJA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "240-468-6009",
        "authorized_official_credential": "NURSE"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "DC",
            "license": "012218-388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Washington, DC
• Providers in Washington, DC by specialty
• Community/Behavioral Health Agency in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; 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.