Provider Demographics
NPI:1740937341
Name:LIVING WATER HOME HEALTH CORPORATION
Entity type:Organization
Organization Name:LIVING WATER HOME HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO/SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:AZIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-354-0916
Mailing Address - Street 1:221 E WALNUT ST STE 255B
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1585
Mailing Address - Country:US
Mailing Address - Phone:626-354-0916
Mailing Address - Fax:626-900-1114
Practice Address - Street 1:14545 FRIAR ST STE 188
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2397
Practice Address - Country:US
Practice Address - Phone:626-354-0916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health