Provider Demographics
NPI:1750271748
Name:LIVING WATERS LLC
Entity type:Organization
Organization Name:LIVING WATERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-378-9911
Mailing Address - Street 1:855 S CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1810
Mailing Address - Country:US
Mailing Address - Phone:208-378-9911
Mailing Address - Fax:
Practice Address - Street 1:855 S CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1810
Practice Address - Country:US
Practice Address - Phone:208-378-9911
Practice Address - Fax:208-378-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service