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General NPI Number Information
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NPI Number | 1174136568
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Entity Type | Organization
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Legal Business Name | LIVING WORD LUTHERAN CHURCH
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Dates
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Enumeration Date | 08/26/2020
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Last Update Date | 08/26/2020
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Provider Practice Location Address
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Address Line | 46500 N TERRITORIAL RD
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City | PLYMOUTH
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State | MI
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Zip | 48170-3066
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Country | US
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Telephone | 734-207-9673
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Fax |
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Provider Business Mailing Address
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Address Line | 46500 N TERRITORIAL RD
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City | PLYMOUTH
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State | MI
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Zip | 48170-3066
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Country | US
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Telephone | 734-207-9673
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Fax |
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Authorized Official
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Title or Position | CONGREGATION PASTOR
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Name | MR. SAMUEL WATTERS
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Credential |
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Telephone | 734-664-4489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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