Provider Demographics
NPI:1902267131
Name:LIVING WATER HOME HEALTH LLC
Entity Type:Organization
Organization Name:LIVING WATER HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANE
Authorized Official - Middle Name:GILLAM
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-552-0674
Mailing Address - Street 1:PO BOX 2798
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-2738
Mailing Address - Country:US
Mailing Address - Phone:832-552-0674
Mailing Address - Fax:833-260-8598
Practice Address - Street 1:3730 KIRBY DR STE 1200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3985
Practice Address - Country:US
Practice Address - Phone:832-552-0674
Practice Address - Fax:833-260-8598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health