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General NPI Number Information
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NPI Number | 1295455921
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Entity Type | Organization
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Legal Business Name | WATERS LOVING CARE
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 2603 OLIVIA LN
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City | SOUTHAVEN
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State | MS
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Zip | 38672-6552
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Country | US
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Telephone | 901-644-8264
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Fax |
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Provider Business Mailing Address
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Address Line | 2603 OLIVIA LN
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City | SOUTHAVEN
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State | MS
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Zip | 38672-6552
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Country | US
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Telephone | 901-664-8264
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JENNIFER WATERS
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Credential |
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Telephone | 901-644-8264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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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 | 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 #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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