Living Waters Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

LIVING WATERS HOSPICE LLC

Practice address

3711 US Highway 68
Golden Valley, AZ 86413-7522

Phone

(928) 565-9000

Fax

(928) 565-9001

NPI assigned

Apr 27, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Randy Denham, MSW

Title

Vice President

Phone

(928) 565-9000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Hospice certification: CCN 031611

Legal name

LIVING WATERS HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Nov 28, 2012

Last certification

Jun 8, 2021

Ownership / control type

Other

Organization structure

LLCProprietary

Incorporated

Jan 18, 2012 in AZ

Enrollment address

3711W Highway 68
Golden Valley, AZ 86413-7522

Listed as

Living Waters Hospice, LLCCCN 031611 · All quality measures

Ownership

Other

Certified

Nov 28, 2012

Medicare certification status

ActiveFrom the Provider of Services file

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 4

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• John A Weidner, D.O.

  • Family Medicine Physician
  • Kingman, AZ
  • NPI 1467438143

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Michael Andrew Treiman, MD

  • Emergency Medicine Physician
  • Phoenix, AZ
  • NPI 1073803631

  Hospice

  Care Compare affiliation
• John A Weidner, D.O.

  • Family Medicine Physician
  • Kingman, AZ
  • NPI 1467438143

  Hospice

  Care Compare affiliation
• Dana Shawn Vitale, D.O.

  • Emergency Medicine Physician
  • North Las Vegas, NV
  • NPI 1164450524

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364256000000",
    "number": "1922366947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4195 HIGHWAY 68,",
            "address_2": "C-902",
            "city": "GOLDEN VALLEY",
            "state": "AZ",
            "postal_code": "86413",
            "telephone_number": "928-565-9000",
            "fax_number": "928-565-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3711 US HIGHWAY 68",
            "city": "GOLDEN VALLEY",
            "state": "AZ",
            "postal_code": "864137522",
            "telephone_number": "928-565-9000",
            "fax_number": "928-565-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WATERS HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-27",
        "last_updated": "2013-03-26",
        "status": "A",
        "authorized_official_last_name": "DENHAM",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "928-565-9000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Frazey, L.P.N.
• Elizabeth Gallion, MS MAED LASAC
• H.O.a.N.J., LLC
• High Desert Wound Care
• Norma June Jones, CPHT
• Morgan Consulting LLC
• Wilfred J Radler, M.D.
• Erin Reiman, RN, BSN
• John Randolph Scott, D.D.S.
• Holly J Stueckrath

• Community Based Hospice Care Agency in Golden Valley, AZ
• Providers in Golden Valley, AZ by specialty
• Community Based Hospice Care Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; 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.