Provider Demographics
NPI:1386900447
Name:LIVING STONES INTERNATIONAL, INC.
Entity type:Organization
Organization Name:LIVING STONES INTERNATIONAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBOA-MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-765-0320
Mailing Address - Street 1:PO BOX 6747
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32314-6747
Mailing Address - Country:US
Mailing Address - Phone:850-765-0320
Mailing Address - Fax:850-765-0485
Practice Address - Street 1:604 EUGENIA ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310-4818
Practice Address - Country:US
Practice Address - Phone:850-765-0320
Practice Address - Fax:850-765-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management