Provider Demographics
NPI:1316716285
Name:LILY WATERS SERVICES INC
Entity type:Organization
Organization Name:LILY WATERS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:AKINTUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-806-6938
Mailing Address - Street 1:650 MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5448
Mailing Address - Country:US
Mailing Address - Phone:207-904-0770
Mailing Address - Fax:
Practice Address - Street 1:650 MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5448
Practice Address - Country:US
Practice Address - Phone:207-904-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care