NPIMap

Organization Active NPI

The Waters of Roan Highlands LLC

  • Skilled Nursing Facility
  • Roan Mountain, TN
National Provider Identifier
1205389657
Registry record updated Aug 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
THE WATERS OF ROAN HIGHLANDS LLC
Practice address
146 Buck Creek Rd
Roan Mountain, TN 37687-3497
Phone
(423) 772-0161
Fax
(423) 772-3481
NPI assigned
Aug 2, 2016
Last updated
Aug 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2016

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

Authorized official

Name
Moishe Gubin
Title
Member
Phone
(708) 449-1900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

146 Buck Creek Rd
Roan Mountain, TN 37687-3497

Mailing address

146 Buck Creek Rd
Roan Mountain, TN 37687-3497
Phone (423) 772-0161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170609002200 TN Part A Provider - Skilled Nursing Facility 5496023749 Practice locations: Roan Mountain, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205389657. Details of each certification follow.

Skilled nursing facility certification: CCN 445396

Legal name
THE WATERS OF ROAN HIGHLANDS, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 20, 1997
Last certification
Mar 16, 2022
Beds
80
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
146 Buck Creek Rd
Roan Mountain, TN 37687-3497
Nursing home name
THE WATERS OF ROAN HIGHLANDS,LLC
Affiliated entity
INFINITY HEALTHCARE CONSULTING

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Waters of Roan Highlands,LLCCCN 445396 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 20, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8071.9 residents per day on average
Chain
Infinity Healthcare Consulting69 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0983355Waters of Roan Highlands, LLC, the146 Buck Creek Road, Roan Mountain, TN 37687Certificate of waiverFeb 21, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gubin Enterprises Limited Partnership Organization, South Bend, IN 5% Or Greater Direct Ownership Interest Aug 1, 2016 40%
Erika L Cable Individual W-2 Managing EmployeeAdministrator Jul 28, 2019
A&F Realty LLC Organization, South Bend, IN LLC 5% Or Greater Direct Ownership Interest Aug 1, 2016 20%
Michael Blisko Individual 5% Or Greater Direct Ownership Interest Aug 1, 2016 40%

Facilities with the same owner 31

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 31

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1470096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470096000000",
    "number": "1205389657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 BUCK CREEK RD",
            "city": "ROAN MOUNTAIN",
            "state": "TN",
            "postal_code": "376873497",
            "telephone_number": "423-772-0161",
            "fax_number": "423-772-3481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 BUCK CREEK RD",
            "city": "ROAN MOUNTAIN",
            "state": "TN",
            "postal_code": "376873497",
            "telephone_number": "423-772-0161",
            "fax_number": "423-772-3481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WATERS OF ROAN HIGHLANDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-02",
        "last_updated": "2016-08-02",
        "status": "A",
        "authorized_official_last_name": "GUBIN",
        "authorized_official_first_name": "MOISHE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "708-449-1900"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roan Mountain, TN

Sources for this page

Verify at the official NPI Registry.