Provider Demographics
NPI:1063550762
Name:LIVING WATERS HOME CARE LLC DBA SERVICES UNLIMITED
Entity type:Organization
Organization Name:LIVING WATERS HOME CARE LLC DBA SERVICES UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-372-5150
Mailing Address - Street 1:170 MEMORIAL PARK DR
Mailing Address - Street 2:PO BOX 446
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-9703
Mailing Address - Country:US
Mailing Address - Phone:336-372-5150
Mailing Address - Fax:336-372-1838
Practice Address - Street 1:170 MEMORIAL PARK DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-9703
Practice Address - Country:US
Practice Address - Phone:336-372-5150
Practice Address - Fax:336-372-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1588372500000X, 372600000X, 373H00000X, 3747A0650X, 3747P1801X, 376J00000X, 376K00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409072Medicaid
NC6600622Medicaid