Waterman Convalescent Hospital, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

WATERMAN CONVALESCENT HOSPITAL, LLC

Practice address

1850 N Waterman Ave
San Bernardino, CA 92404-4831

Phone

(909) 882-1215

Fax

(909) 881-2071

NPI assigned

Aug 3, 2005

Organization subpart

No

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

Authorized official

Name

Elizabeth Plott Tyler, J.D.

Title

Vice President of Operations

Phone

(323) 655-6960

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265433957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5455 WILSHIRE BLVD",
            "address_2": "STE 1925",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364201",
            "telephone_number": "323-655-6960",
            "fax_number": "323-655-7122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 N WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044831",
            "telephone_number": "909-882-1215",
            "fax_number": "909-881-2071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERMAN CONVALESCENT HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PLOTT TYLER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "323-655-6960",
        "authorized_official_credential": "J.D."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05565G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charis Linette Washington, MSW, ACSW
• Craig Washington
• Ronnie Washington
• Taylor Washington
• Washingtons Helping Hand LLC
• Waterman Health Inc
• Waterman Medical Supply Inc
• Watermanidence Opco, LLC
• Mary Waters Parks, MSG
• Deon Watkins

• Skilled Nursing Facility in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.