Provider Demographics
NPI:1881201267
Name:LIVING WATERS BUELL LAKE
Entity Type:Organization
Organization Name:LIVING WATERS BUELL LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:CARISSA
Authorized Official - Last Name:SABO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-686-1046
Mailing Address - Street 1:13515 N GENESEE RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-9190
Mailing Address - Country:US
Mailing Address - Phone:810-686-1046
Mailing Address - Fax:
Practice Address - Street 1:13515 N GENESEE RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-9190
Practice Address - Country:US
Practice Address - Phone:810-686-1046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home