Provider Demographics
NPI:1942389507
Name:LIVING WATER'S HOME CARE, LLC
Entity Type:Organization
Organization Name:LIVING WATER'S HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:JOINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-200-3335
Mailing Address - Street 1:623 HENDRIX RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-9241
Mailing Address - Country:US
Mailing Address - Phone:336-372-5978
Mailing Address - Fax:336-372-1838
Practice Address - Street 1:623 HENDRIX RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-9241
Practice Address - Country:US
Practice Address - Phone:336-372-5978
Practice Address - Fax:336-372-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3349251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601479Medicaid