- Enrollment id
- O20130906000403
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1730425760
- Multiple npi flag
- N
- Ccn
- 741543
- Associate id
- 4688817893
- Organization name
- LIVING WATERS HOSPICE, INC.
- Doing business as name
- LIVING WATERS HOSPICE, INC.
- Incorporation date
- 2012-10-22
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 23315 JOHNSON RD
- City
- NEW CANEY
- State
- TX
- Zip code
- 773577561