=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740937341
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVING WATER HOME HEALTH CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2022
-----------------------------------------------------
Last Update Date | 01/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14545 FRIAR ST STE 188
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91411-2397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-354-0916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 E WALNUT ST STE 255B
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-1585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-354-0916
-----------------------------------------------------
Fax | 626-900-1114
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/CFO/SECRETARY
-----------------------------------------------------
Name | MRS. AZIZA GEORGIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-354-0916
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------