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General NPI Number Information
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NPI Number | 1700034428
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Entity Type | Organization
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Legal Business Name | LIVING WATERS VENTURES, INC
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Dates
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Enumeration Date | 09/05/2008
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Last Update Date | 09/05/2008
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Provider Practice Location Address
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Address Line | 1008 LESLIE AVE
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City | CATONSVILLE
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State | MD
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Zip | 21228-2912
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Country | US
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Telephone | 410-878-6741
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 LESLIE AVE
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City | CATONSVILLE
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State | MD
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Zip | 21228-2912
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Country | US
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Telephone | 410-878-6741
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ADE OLUSOJI BANKOLE
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Credential |
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Telephone | 410-878-6741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R2585
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License Number State | MD
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