Living Waters Healthcare Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

LIVING WATERS HEALTHCARE SERVICES LLC

Practice address

13370 SW 131St St Ste 107
Miami, FL 33186-5856

Phone

(786) 713-0954

Fax

(786) 713-0958

NPI assigned

Feb 24, 2025

Organization subpart

No

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

Authorized official

Name

Ileana PetiscoNPI 1225956881

Title

Owner/Administrator

Phone

(786) 713-0954

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861298242. Details of each certification follow.

• CCN 687421 Home health agency · Active · Details

Home health agency certification: CCN 687421

Legal name

LIVING WATERS HEALTHCARE SERVICES LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jan 8, 2026

Last certification

Jan 8, 2026

Organization structure

LLCProprietary

Enrollment address

13370 SW 131St St
Ste 107
Miami, FL 33186-5856
HHA Branch

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ileana Petisco, RN

  • Home Health Registered Nurse
  • Miami, FL
  • NPI 1225956881
  NPD (past) Authorized official
• Anabelle Yeaman

  • Registered Nurse
  • Miami, FL
  • NPI 1932020872
  NPD (past)

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

{
    "created_epoch": "1740355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740355200000",
    "number": "1861298242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13370 SW 131ST ST STE 107",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331865856",
            "telephone_number": "786-713-0954",
            "fax_number": "786-713-0958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13370 SW 131ST ST STE 107",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331865856",
            "telephone_number": "786-713-0954",
            "fax_number": "786-713-0958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WATERS HEALTHCARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-24",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A",
        "authorized_official_last_name": "PETISCO",
        "authorized_official_first_name": "ILEANA",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "786-713-0954"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Miami, FL
• Providers in Miami, FL by specialty
• Home Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.