Provider Demographics
NPI:1992376362
Name:LIVING WATERS HOME HEALTH LLC
Entity Type:Organization
Organization Name:LIVING WATERS HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHA
Authorized Official - Middle Name:CHARLENE
Authorized Official - Last Name:ELGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-412-7310
Mailing Address - Street 1:1201 N LEONARD AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106-1413
Mailing Address - Country:US
Mailing Address - Phone:314-412-7310
Mailing Address - Fax:
Practice Address - Street 1:1201 N LEONARD AVE APT A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1413
Practice Address - Country:US
Practice Address - Phone:314-412-7310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health