The Waters of Huntingburg, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

05-000122-1 Issued in IN

Legal business name

THE WATERS OF HUNTINGBURG, LLC

Practice address

1712 N Leland Dr
Huntingburg, IN 47542-9348

Phone

(812) 683-4090

Fax

(812) 683-2305

NPI assigned

Jun 3, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Michael Blisko

Title

Coo

Phone

(708) 449-1900

Specialties & licenses 1

Addresses

Other identifiers 6

Locations

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337212800000",
    "number": "1306884994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1712 N LELAND DR",
            "city": "HUNTINGBURG",
            "state": "IN",
            "postal_code": "475429348",
            "telephone_number": "812-683-4090",
            "fax_number": "812-683-2305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 N LELAND DR",
            "city": "HUNTINGBURG",
            "state": "IN",
            "postal_code": "475429348",
            "telephone_number": "812-683-4090",
            "fax_number": "812-683-2305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WATERS OF HUNTINGBURG, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2012-05-17",
        "status": "A",
        "authorized_official_last_name": "BLISKO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "708-449-1900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IN",
            "license": "05-000122-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM ST",
            "identifier": "000000391203",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PT",
            "identifier": "000000391202",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100290560C",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM OT",
            "identifier": "000000391200",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000381425",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC REGION B SUPPLIER#",
            "identifier": "5586190001",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St Josephs Hospital of Huntingburg Inc
• St. Joseph'S Hospital
• Jordan M Sutton, DPT
• Harry Louis Switzer, DDS
• The Huntingburg Clinic
• The Wellness Center of Indiana, LLC
• Charles Albert Tollett Jr., MD
• Transition Home Health Services, LLC
• Transitional Services Sub, LLC
• Transitional Services, Inc

• Skilled Nursing Facility in Huntingburg, IN
• Providers in Huntingburg, 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 May 17, 2012; 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.