Living Waters Group Home

LBN: Living Waters Group Home
Living Waters Group Home is an health care organization with primary practice located at 1609 Sweetgum Cir , Fayetteville NC 28304-2707. The organization recently has only one registered license in Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children, which is considered as the primary health care specialty. Living Waters Group Home can be contacted via phone (910) 867-3279, or through Ealy, Beverly Ann via phone (910) 717-6127.

Contact Information

Primary practice address
1609 Sweetgum Cir Fayetteville NC 28304-2707
Phone: (910) 867-3279
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Ealy, Beverly Ann
Phone: (910) 717-6127

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children 322D00000X MHL 026-796 North Carolina

Profile Details

NPI number 1447390042
LBN Legal business name Living Waters Group Home
DBA Doing business as
Authorized official Ealy, Beverly Ann
Entity Organization
Organization subpart 1 No
Enumeration date Feb 6th, 2007
Last updated Aug 22nd, 2020 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447390042 NPPES
North Carolina MEDICAID 6603850

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