Healthcare Provider Details

I. General information

NPI: 1598203689
Provider Name (Legal Business Name): LIVING WATER FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
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: 318-343-6966
  • Fax: 318-345-7123
Mailing address:
  • Phone: 318-343-6966
  • Fax: 318-345-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: LASHUNTA SHARLAN PRINGLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-548-9355