Healthcare Provider Details

I. General information

NPI: 1275497778
Provider Name (Legal Business Name): CATHEDRAL OF LIVING WATERS INC. DBA LIVING WATERS TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 CLINTON AVE APT 2
JERSEY CITY NJ
07304-1608
US

IV. Provider business mailing address

254 CLINTON AVE APT 2
JERSEY CITY NJ
07304-1608
US

V. Phone/Fax

Practice location:
  • Phone: 917-830-2539
  • Fax:
Mailing address:
  • Phone: 917-830-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State

VIII. Authorized Official

Name: TAYANA ALISHA THOMPSON
Title or Position: REV.
Credential: REV, LPN. PHD
Phone: 917-830-5239