LIVING WATERS GROUP HOME #2 (NPI# 1487890380) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487890380 |
| Entity Type | Organization |
| Organization Name | LIVING WATERS GROUP HOME #2 |
| Practice Address |
1264 Davis Bridge Rd Parkton NC 28371-9621 |
| Mailing Address |
8419 Cartman Dr Fayetteville NC 28314-8419 |
| Practice Telephone | 9108581403 |
| Practice Fax Number | 9103391844 |
| Mailing Telephone | 9107176127 |
| Mailing Fax Number | 9103391844 |
| Enumeration Date | 2008-12-23 |
| Last Update Date | 2008-12-23 |
| Authorized Official Name | BEVERLY ANN EALY (DIRECTOR) |
| Authorized Official Telephone | 9107176127 |
| Is Organization Subpart | Y |
| Parent Organization Name | LIVING WATER GROUP HOME #2 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | MHL-078-219 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 6603850 | 05 |
| Street Address |
1264 DAVIS BRIDGE RD |
| City | PARKTON |
| State | NC |
| Zip Code | 28371-9621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316427859 | Sharon Ruiz | Respiratory Therapist, Registered | 154 David Parnel St, Parkton, NC 28371 | 2018-08-15 |
| 1477079663 | Breathe Rc LLC | Respiratory Therapist, Registered | 154 David Parnell St, Parkton, NC 28371 | 2017-08-18 |
| 1154719367 | Parkton Emergency Medical Services Inc | Ambulance | 19 W. 3rd Street, Parkton, NC 28371 | 2014-12-23 |
| 1184041766 | Aci Support Specialists | Case Management | 1632 Yarboro Road, Parkton, NC 28371 | 2014-03-21 |
| 1578747762 | Green Manor Rest Home, Inc. | Assisted Living Facility | 1083 West Parkton Tobemory Road, Parkton, NC 28371 | 2007-12-24 |
| 1396896353 | Terry Annette Askew | Registered Nurse | 1465 Thoroughbred Trail, Parkton, NC 28371 | 2007-01-16 |
| 1295769149 | Hope Thru Horses Inc | Social Worker | 1860 Armory Rd, Parkton, NC 28371 | 2006-07-10 |
| 1558917179 | Hiede Jean Erickson | Social Worker | 1860 Armory Rd, Parkton, NC 28371 | 2019-08-11 |
| 1649627068 | Destini Edens | Counselor | 1860 Armory Rd, Parkton, NC 28371 | 2016-05-16 |
| 1407884596 | Parkton Family Medical Center | Clinic/Center | 15 W Third St, Parkton, NC 28371 | 2006-06-29 |
| Find all providers in zip 28371 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578160552 | Residential Option Serving Adolescents, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2316 Carved Tree Ln, Charlotte, NC 28262-3154 | 2020-10-03 |
| 1649895442 | Gaynelle Bolling | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 102 Mandarin Dr, Pikeville, NC 27863-0020 | 2020-06-08 |
| 1851913966 | Johnson Enrichment Services LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 221 Foxcroft Dr, Winston Salem, NC 27103-5313 | 2020-05-12 |
| 1881230795 | Walter Jason Young Jr. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 412 Rook Rd, Charlotte, NC 28216-3199 | 2019-11-26 |
| 1750935839 | Heavenly Touch Residential Care | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4720 Baileys Lake Rd Nw Apt 204, Concord, NC 28027-8576 | 2019-07-28 |
| 1073166245 | Making Kids Matter, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 409 Hunton Forest Dr Nw, Concord, NC 28027-0186 | 2019-07-17 |
| 1891357752 | New Hope for Tomorrow LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 528 Baldwin Rd, Burlington, NC 27217-1702 | 2019-07-01 |
| 1114490877 | Brenda Gail Cannon | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3105 Vico Ter, Raleigh, NC 27610-5951 | 2019-01-05 |
| 1356813455 | Lamesha Marshall | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3335 Avalon Ave, Charlotte, NC 28208-3378 | 2018-12-31 |
| 1487131074 | Ronald Anthony Benjamin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1594 Candace Ridge Dr, Greensboro, NC 27406-8595 | 2018-07-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.