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Organization

LIVING WATERS GROUP HOME

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. BEVERLY ANN EALY (RESIDENTIAL DIRECTOR)
(910) 717-6127
Entity
Organization

Contact information

Practice address
1609 SWEETGUM CIR, FAYETTEVILLE, NC 28304-2707
(910) 867-3279
Mailing address
8419 CARTMAN DR, FAYETTEVILLE, NC 28314-8419
(910) 487-2630

Taxonomy

Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL 026-796
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6603850
NC
Enumeration date
02/06/2007
Last updated
08/22/2020
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