Provider Demographics
NPI:1053100297
Name:LIVING WATER FAMILY HOME
Entity type:Organization
Organization Name:LIVING WATER FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-560-8991
Mailing Address - Street 1:5440 W PLACIDE CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-0982
Mailing Address - Country:US
Mailing Address - Phone:631-560-8991
Mailing Address - Fax:
Practice Address - Street 1:5440 W PLACIDE CIR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-0982
Practice Address - Country:US
Practice Address - Phone:631-560-8991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services