Waters' Provider Care Services, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL-054-124 Issued in NC

Legal business name

WATERS' PROVIDER CARE SERVICES, INC.

Practice address

104 W James St
La Grange, NC 28551-1727

Phone

(252) 566-3600

NPI assigned

Feb 7, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Eric Waters

Title

Secretary - Treasurer

Phone

(252) 566-3600

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629118013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 W JAMES ST",
            "city": "LA GRANGE",
            "state": "NC",
            "postal_code": "285511727",
            "telephone_number": "252-566-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W JAMES ST",
            "city": "LA GRANGE",
            "state": "NC",
            "postal_code": "285511727",
            "telephone_number": "252-566-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERS' PROVIDER CARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WATERS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ERIC",
        "authorized_official_title_or_position": "SECRETARY - TREASURER",
        "authorized_official_telephone_number": "252-566-3600"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-054-124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in La Grange, NC
• Providers in La Grange, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.