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General NPI Number Information
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NPI Number | 1225203771
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Entity Type | Organization
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Legal Business Name | LIVING WATERS CHRISTIAN FELLOWSHIP
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 15555 WARWICK BLVD SUITE F
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-2177
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Country | US
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Telephone | 757-820-0717
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Fax | 757-820-0716
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Provider Business Mailing Address
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Address Line | 15555 WARWICK BLVD SUITE F
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-2177
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Country | US
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Telephone | 757-820-0717
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Fax | 757-820-0716
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Authorized Official
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Title or Position | PASTOR
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Name | MR. PASTOR CHARLIE AMMONS
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Credential |
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Telephone | 757-820-0717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 0904003893
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License Number State | VA
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