Provider Demographics
NPI:1780279117
Name:LIVING WATER FOR LIFE MEDICAL MINISTRY
Entity type:Organization
Organization Name:LIVING WATER FOR LIFE MEDICAL MINISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-598-0903
Mailing Address - Street 1:11435 W BUCKEYE RD STE 104-271
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-6812
Mailing Address - Country:US
Mailing Address - Phone:602-598-0903
Mailing Address - Fax:
Practice Address - Street 1:11435 W BUCKEYE RD STE 104-271
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-6812
Practice Address - Country:US
Practice Address - Phone:602-598-0903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251K00000XAgenciesPublic Health or Welfare