NPIMap

Organization Active NPI

Livingwaters

  • Community/Behavioral Health Agency
  • Fayetteville, NC
National Provider Identifier
1952441222
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL 026-796 Issued in NC
Legal business name
LIVINGWATERS
Practice address
8383 Cliffdale Rd.
Fayetteville, NC 28314-5853
Phone
(910) 717-6127
Fax
(910) 717-6127
NPI assigned
Feb 7, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Preston Ray Ealy
Title
Administrative Director
Phone
(910) 717-6127

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MHL 026-796 NC Primary

Addresses

Primary practice location

8383 Cliffdale Rd.
Fayetteville, NC 28314-5853

Mailing address

8419 Cartman Dr
Fayetteville, NC 28314-8419
Phone (910) 487-2630

Other identifiers 1

IdentifierTypeStateIssuer
3418072MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Living Waters Group Home4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8383 Cliffdale Rd
Fayetteville, NC 28314
Phone (910) 717-6127

NPI Registry JSON

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": "1952441222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8419 CARTMAN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283148419",
            "telephone_number": "910-487-2630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8383 CLIFFDALE RD.",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283145853",
            "telephone_number": "910-717-6127",
            "fax_number": "910-717-6127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVINGWATERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EALY",
        "authorized_official_first_name": "PRESTON",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "910-717-6127",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL 026-796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418072",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • 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.