Provider Demographics
NPI:1912058975
Name:LIVING WATERS HOME CARE, LLC
Entity Type:Organization
Organization Name:LIVING WATERS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:JOINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-372-5978
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:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3349251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418106Medicaid