Living Water Community Development Corporation, Inc

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

LIVING WATER COMMUNITY DEVELOPMENT CORPORATION, INC

Practice address

3906 Hickory Grove Rd
Mount Holly, NC 28120-9618

Phone

(704) 822-3004

Fax

(704) 827-6031

NPI assigned

Dec 19, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Andrea Lenor Gooding, PHD

Title

Ceo

Phone

(704) 822-3004

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881757938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 267",
            "city": "MOUNT HOLLY",
            "state": "NC",
            "postal_code": "281200267",
            "telephone_number": "704-822-3004",
            "fax_number": "704-827-6031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3906 HICKORY GROVE RD",
            "city": "MOUNT HOLLY",
            "state": "NC",
            "postal_code": "281209618",
            "telephone_number": "704-822-3004",
            "fax_number": "704-827-6031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WATER COMMUNITY DEVELOPMENT CORPORATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOODING",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "LENOR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-822-3004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8700401",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Case Management Agency in Mount Holly, NC
• Providers in Mount Holly, NC by specialty
• Case Management Agency 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.