| NPI | 1235439159 |
|---|---|
| Former Legal Business Name | LIVING WATERS OUTREACH PROGRAM |
| Entity Type | Organization |
| Authorized Contact | TERRY CHRISTOPHER SPEAKS Case Manager 336-710-2019 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2010-10-26 |