Provider Demographics
NPI:1679504401
Name:LIVING-WATER HEALTHCARE SERVICES LLC.
Entity Type:Organization
Organization Name:LIVING-WATER HEALTHCARE SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOSEDE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADETUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-596-4626
Mailing Address - Street 1:2021 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:256
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3568
Mailing Address - Country:US
Mailing Address - Phone:614-596-4626
Mailing Address - Fax:
Practice Address - Street 1:2021 E DUBLIN GRANVILLE RD
Practice Address - Street 2:256
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3568
Practice Address - Country:US
Practice Address - Phone:614-596-4626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2530863251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2630399Medicaid