Watershed and Ark of Salvation Ministries

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

33853601 Issued in PA

Legal business name

WATERSHED AND ARK OF SALVATION MINISTRIES

Practice address

5265 Roosevelt Blvd
Philadelphia, PA 19124-1720

Phone

(267) 575-0858

NPI assigned

Jul 25, 2017

Organization subpart

No

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

Authorized official

Name

Anna Ebun Ogunlokun

Title

Administrator

Phone

(267) 575-0858

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1235652959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5265 ROOSEVELT BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191241720",
            "telephone_number": "267-575-0858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5265 ROOSEVELT BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191241720",
            "telephone_number": "267-575-0858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERSHED AND ARK OF SALVATION MINISTRIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-25",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "OGUNLOKUN",
        "authorized_official_first_name": "ANNA",
        "authorized_official_middle_name": "EBUN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "267-575-0858"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "PA",
            "license": "33853601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME CARE AGENCY",
            "identifier": "33853601",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Waters
• Patrick Timothy Waters, D.O., F.A.A.F.P
• Tiffany Waters
• Todd Bantom Waters, M.S. NCC
• Trinique Waters, RD, LDN
• Shanley Waterson
• Zenikee Watford, RBT
• Connor Andrew Wathen, MD
• Naomi Marie Watkins-Granville
• Anthony Watkins, MD

• In Home Supportive Care Agency in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• In Home Supportive Care Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.