Provider Demographics
NPI:1295023679
Name:THE LIVING WATER
Entity Type:Organization
Organization Name:THE LIVING WATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:LAQUAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-722-4056
Mailing Address - Street 1:7504 CHIPMUNK WAY
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610
Mailing Address - Country:US
Mailing Address - Phone:916-722-4056
Mailing Address - Fax:916-722-4056
Practice Address - Street 1:7504 CHIPMUNK WAY
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610
Practice Address - Country:US
Practice Address - Phone:916-722-4056
Practice Address - Fax:916-722-4056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347003886320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5233058OtherKAISER PERMENANTE