The Waters of Lagrange Skilled Nursing Facility LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

THE WATERS OF LAGRANGE SKILLED NURSING FACILITY LLC

Practice address

787 N Detroit St
Lagrange, IN 46761-1111

Phone

(260) 463-2172

NPI assigned

Nov 10, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeffrey Sax

Title

Manager

Phone

(219) 898-5705

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1043928807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 FENCL LN",
            "city": "HILLSIDE",
            "state": "IL",
            "postal_code": "601622067",
            "telephone_number": "708-449-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "787 N DETROIT ST",
            "city": "LAGRANGE",
            "state": "IN",
            "postal_code": "467611111",
            "telephone_number": "260-463-2172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WATERS OF LAGRANGE SKILLED NURSING FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-10",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "SAX",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "219-898-5705"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ariel Spencer, M.D.
• Angie Stinson, FNP-C
• Annastasia Stover
• Dee L Strycker, LMHC
• Lisa Rene Terry, RN
• Gabriel Thomas, PHARMD
• Mary Susan Thuillard
• Wade Troyer, DDS
• Eleonor Vanover, NP-C
• Amanda Venters

• Skilled Nursing Facility in Lagrange, IN
• Providers in Lagrange, IN by specialty
• Skilled Nursing Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.