Provider Demographics
NPI:1174136568
Name:LIVING WORD LUTHERAN CHURCH
Entity type:Organization
Organization Name:LIVING WORD LUTHERAN CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONGREGATION PASTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-664-4489
Mailing Address - Street 1:46500 N TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3066
Mailing Address - Country:US
Mailing Address - Phone:734-207-9673
Mailing Address - Fax:
Practice Address - Street 1:46500 N TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3066
Practice Address - Country:US
Practice Address - Phone:734-207-9673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty