Provider Demographics
NPI:1386196608
Name:LIVING WATERS INTERNATIONAL MINISTRIES
Entity Type:Organization
Organization Name:LIVING WATERS INTERNATIONAL MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-790-7707
Mailing Address - Street 1:1314 SW 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1907
Mailing Address - Country:US
Mailing Address - Phone:954-790-7707
Mailing Address - Fax:
Practice Address - Street 1:7950 SW 30TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1979
Practice Address - Country:US
Practice Address - Phone:954-790-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6661101YA0400X, 101YP1600X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty