Provider Demographics
NPI:1205489622
Name:LIVING WATERS OF KY, INC
Entity type:Organization
Organization Name:LIVING WATERS OF KY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-270-6919
Mailing Address - Street 1:920 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2152
Mailing Address - Country:US
Mailing Address - Phone:859-305-6673
Mailing Address - Fax:859-305-6674
Practice Address - Street 1:920 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2152
Practice Address - Country:US
Practice Address - Phone:859-305-6673
Practice Address - Fax:859-305-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY800328OtherBHSO
KY810689OtherAODE