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General NPI Number Information
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NPI Number | 1275497778
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Entity Type | Organization
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Legal Business Name | CATHEDRAL OF LIVING WATERS INC. DBA LIVING WATERS TRANSPORT
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 254 CLINTON AVE APT 2
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City | JERSEY CITY
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State | NJ
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Zip | 07304-1608
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Country | US
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Telephone | 917-830-2539
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Fax |
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Provider Business Mailing Address
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Address Line | 254 CLINTON AVE APT 2
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City | JERSEY CITY
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State | NJ
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Zip | 07304-1608
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Country | US
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Telephone | 917-830-2539
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Fax |
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Authorized Official
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Title or Position | REV.
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Name | TAYANA ALISHA THOMPSON
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Credential | REV, LPN. PHD
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Telephone | 917-830-5239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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