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 |