ABUNDANT LIFE TREATMENT CENTER — NPI 1467741058 (Licensed & Credentialed Preferred Provider Organization in TARBORO, NC)

CMS-1500 Box 24J / 33a • NPI

1467741058

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

305R00000X

Licensed & Credentialed Preferred Provider Organization

Box 32 Service Location & ZIP+4

108 W HOPE LODGE ST, TARBORO, NC, 27886-2439

✓ 9-Digit EDI 837 ZIP+4 (27886-2439)

Practice Phone & Referral Fax

(252) 774-4100

Fax: (252) 774-4100

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1467741058 (ABUNDANT LIFE TREATMENT CENTER) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1467741058` (NPI-2 Organization / Facility)
Provider / Legal Name	ABUNDANT LIFE TREATMENT CENTER
Plain-English Specialty	Licensed & Credentialed Preferred Provider Organization NUCC Code: `305R00000X` (Preferred Provider Organization)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	108 W HOPE LODGE ST, TARBORO, NC, 27886-2439
Practice Telephone / Fax	Tel: (252) 774-4100 \| Fax: (252) 774-4100
Administrative Mailing Address	PO BOX 1427, TARBORO, NC, 27886-1427
Enumeration & Last Sync	Enumerated: 2011-04-04 \| CMS Record Updated: 2011-04-04
Authorized Official	GERENDA WILLIAMS (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

108 W HOPE LODGE ST, TARBORO, NC, 27886-2439

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Plain-English Taxonomy & CMS Crosswalk (305R00000X)

What Does Taxonomy Code 305R00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 305R00000X translates to:
"Licensed & Credentialed Preferred Provider Organization"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Preferred Provider Organization for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ABUNDANT LIFE TREATMENT CENTER)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`305R00000X` — Preferred Provider Organization Plain English: Licensed & Credentialed Preferred Provider Organization	State: NC \| License: `033097` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ABUNDANT LIFE TREATMENT CENTER (NPI #1467741058)