NPIMap

Organization Active NPI

Living Waters Group Home #2

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Parkton, NC
National Provider Identifier
1487890380
Registry record updated Dec 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL-078-219 Issued in NC
Legal business name
LIVING WATERS GROUP HOME #2
Practice address
1264 Davis Bridge Rd
Parkton, NC 28371-9621
Phone
(910) 858-1403
Fax
(910) 339-1844
NPI assigned
Dec 23, 2008
Last updated
Dec 23, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
LIVING WATER GROUP HOME #2As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 23, 2008

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-078-219 NC Primary

Addresses

Primary practice location

1264 Davis Bridge Rd
Parkton, NC 28371-9621

Mailing address

8419 Cartman Dr
Fayetteville, NC 28314-8419
Phone (910) 717-6127

Other identifiers 1

IdentifierTypeStateIssuer
6603850MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Living Waters Group Home 24 organizations share this tax ID, including this one
Part of
Living Waters Group Home 2

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1229990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229990400000",
    "number": "1487890380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8419 CARTMAN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283148419",
            "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": "1264 DAVIS BRIDGE RD",
            "city": "PARKTON",
            "state": "NC",
            "postal_code": "283719621",
            "telephone_number": "910-858-1403",
            "fax_number": "910-339-1844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WATERS GROUP HOME #2",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIVING WATER GROUP HOME #2",
        "enumeration_date": "2008-12-23",
        "last_updated": "2008-12-23",
        "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"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-078-219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603850",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Parkton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2008; 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.