Healthcare Provider Details

I. General information

NPI: 1194295980
Provider Name (Legal Business Name): LIVING WATER FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 HIGHWAY 80 E
MONROE LA
71203-8527
US

IV. Provider business mailing address

645 HIGHWAY 80 E
MONROE LA
71203-8527
US

V. Phone/Fax

Practice location:
  • Phone: 318-343-8744
  • Fax: 318-345-7123
Mailing address:
  • Phone: 318-343-8744
  • Fax: 318-345-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: ADRIAN FISHER
Title or Position: OWNER
Credential:
Phone: 318-614-7644