# WATERS' PROVIDER CARE SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629118013
- **Authorized official:** JOHN ERIC WATERS (SECRETARY - TREASURER)
- **Authorized official phone:** (252) 566-3600

## Contact information

- **Practice address:** 104 W JAMES ST, LA GRANGE, NC 28551-1727
- **Practice address phone:** (252) 566-3600
- **Mailing address:** 104 W JAMES ST, LA GRANGE, NC 28551-1727
- **Mailing address phone:** (252) 566-3600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-054-124 | NC | Yes |

## Other

- **Enumeration date:** 02/07/2007
- **Last updated:** 08/22/2020