Organization
LIVING WATERS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMBER ELLIS APRN (DIRECTOR/FAMILY NURSE PRACTITIONER)
(304) 946-8350
Entity
Organization
Contact information
Practice address
100 MAIN AVE, LOGAN, WV 25601-3323
(304) 946-8350
Mailing address
100 MAIN AVE, LOGAN, WV 25601-3323
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
05/31/2019
Last updated
03/26/2025
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