NPIMap

Organization Active NPI

Living Waters Group Home

  • Community/Behavioral Health Agency
  • Fayetteville, NC
National Provider Identifier
1013145614
Registry record updated Jun 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LIVING WATERS GROUP HOME
Practice address
8383 Cliffdale Rd
Fayetteville, NC 28314-5853
Phone
(910) 717-6127
Fax
(910) 339-1844
NPI assigned
Jun 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Beverly Ann Ealy
Title
Director
Phone
(910) 717-6127

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

8383 Cliffdale Rd
Fayetteville, NC 28314-5853

Mailing address

8383 Cliffdale Rd
Fayetteville, NC 28314-5853
Phone (910) 717-6127

National Provider Directory

National Provider Directory
Tax ID family
Livingwaters4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8383 Cliffdale Rd
Fayetteville, NC 28314
Phone (910) 717-6127

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245715200000",
    "number": "1013145614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8383 CLIFFDALE RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283145853",
            "telephone_number": "910-717-6127",
            "fax_number": "910-339-1844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8383 CLIFFDALE RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283145853",
            "telephone_number": "910-717-6127",
            "fax_number": "910-339-1844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WATERS GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-23",
        "last_updated": "2009-06-23",
        "status": "A",
        "authorized_official_last_name": "EALY",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-717-6127",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.