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LIVING WATERS GROUP HOME
NPI 1447390042
Residential Treatment Facility, Emotionally Disturbed Children in Fayetteville, NC

Active since February 06, 2007
1609 SWEETGUM CIR, FAYETTEVILLE, NC 28304(910) 867-3279 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Living Waters Group Home NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LIVING WATERS GROUP HOME (NPI 1447390042) is a healthcare organization registered as a residential treatment facility, emotionally disturbed children in Fayetteville, North Carolina and active in the NPI registry since February 2007. The organization lists Beverly Ann Ealy, Residential Director, as its authorized official.

NPPES Registry Identity

NPI1447390042
Entity TypeOrganization
Primary Taxonomy322D00000X
Legal Business NameLIVING WATERS GROUP HOME
Location Address1609 SWEETGUM CIRFayetteville, NC 28304-2707
Mailing Address8419 Cartman DrFayetteville, NC 28314-8419 · (910) 487-2630
Phone(910) 867-3279
Organization SubpartNo
Authorized OfficialBeverly Ann EalyResidential Director · (910) 717-6127
Enumeration DateFebruary 6, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1447390042 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyResidential Treatment Facility, Emotionally Disturbed ChildrenResidential Treatment Facilities
Taxonomy Code322D00000X
License✔ Licensed in NC · MHL 026-796
Definition
A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.
1609 SWEETGUM CIR, Fayetteville, NC 28304
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Other Identifiers 1

Medicaid6603850NC

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. WALTER TYRONE MILLSAP
Counselor
1609 SWEETGUM CIR
FAYETTEVILLE, NC 28304
Cumberland County (910) 867-3279
MISS TRUNETTE LEWIS
Counselor
1609 SWEETGUM CIR
FAYETTEVILLE, NC 28304
Cumberland County (910) 867-3279
MR. LARRY DARNELL MORRISON
Counselor
1609 SWEETGUM CIR
FAYETTEVILLE, NC 28304
Cumberland County (910) 867-3279

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Living Waters Group Home's NPI number?

The NPI number for Living Waters Group Home is 1447390042. It was assigned to this organization in the NPPES registry on February 6, 2007.

Where is Living Waters Group Home located?

Living Waters Group Home is located at 1609 Sweetgum Cir, Fayetteville, NC 28304. The listed phone number is (910) 867-3279.

What is Living Waters Group Home's specialty?

The primary specialty registered for this NPI is Residential Treatment Facility, Emotionally Disturbed Children with taxonomy code 322D00000X.

When was this NPI record last updated?

The NPPES record for Living Waters Group Home was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.