Living Waters Buell Lake

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

LIVING WATERS BUELL LAKE

Practice address

13515 N Genesee Rd
Clio, MI 48420-9190

Phone

(810) 686-1046

NPI assigned

Sep 29, 2020

Organization subpart

No

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

Authorized official

Name

Nicole Carissa Sabo

Title

Director

Phone

(810) 686-1046

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1601337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1881201267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13515 N GENESEE RD",
            "city": "CLIO",
            "state": "MI",
            "postal_code": "484209190",
            "telephone_number": "810-686-1046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13515 N GENESEE RD",
            "city": "CLIO",
            "state": "MI",
            "postal_code": "484209190",
            "telephone_number": "810-686-1046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WATERS BUELL LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-29",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A",
        "authorized_official_last_name": "SABO",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "CARISSA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "810-686-1046"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Lynn Lembach-Witmer, COTA/L
• Victor Leon
• Deron J Lewis, MPT
• Natalie Little, PA-C
• Living Empathy LLC
• Alysssa L Long
• Lorraine Byers-Miller O.D., P.C.
• Donald Christ Lutz, DPM
• Michelle D Lynch, LCOTA
• Nicole Ann Mangett, FNP-C

• Adult Care Home Facility in Clio, MI
• Providers in Clio, MI by specialty
• Adult Care Home Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.