NPIMap

Organization Active NPI

Waters of Clinton LLC

  • Skilled Nursing Facility
  • Clinton, TN
National Provider Identifier
1336693357
Registry record updated Apr 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WATERS OF CLINTON LLC
Practice address
220 Longmire Rd
Clinton, TN 37716-7338
Phone
(865) 457-6925
NPI assigned
Aug 8, 2016
Last updated
Apr 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2023

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

Authorized official

Name
Michael Blisko
Title
Ceo
Phone
(708) 449-1900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

220 Longmire Rd
Clinton, TN 37716-7338

Mailing address

220 Longmire Rd
Clinton, TN 37716-7338
Phone (865) 457-6925

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161123000150 TN Part A Provider - Skilled Nursing Facility 9537448105 Practice locations: Clinton, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336693357. Details of each certification follow.

Skilled nursing facility certification: CCN 445135

Legal name
WATERS OF CLINTON LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 20, 1980
Last certification
Apr 26, 2022
Beds
120
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Infinity Healthcare
Organization structure
LLCProprietary
Enrollment address
220 Longmire Rd
Clinton, TN 37716-7338
Nursing home name
THE WATERS OF CLINTON, LLC
Affiliated entity
INFINITY HEALTHCARE CONSULTING

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Waters of Clinton, LLCCCN 445135 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 20, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12098.8 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
44D0685268Waters of Clinton, the220 Longmire Rd, Clinton, TN 37716Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

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 For-profit 5% Or Greater Direct Ownership Interest Sep 1, 2016 50%
Michael Blisko Individual 5% Or Greater Direct Ownership InterestManager Sep 1, 2016 50%
Jamie Selbe Individual W-2 Managing EmployeeAdministrator Aug 23, 2021

Facilities with the same owner 30

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

View all 30

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680739200000",
    "number": "1336693357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 LONGMIRE RD",
            "city": "CLINTON",
            "state": "TN",
            "postal_code": "377167338",
            "telephone_number": "865-457-6925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 LONGMIRE RD",
            "city": "CLINTON",
            "state": "TN",
            "postal_code": "377167338",
            "telephone_number": "865-457-6925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERS OF CLINTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-08",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A",
        "authorized_official_last_name": "BLISKO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-449-1900"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, TN

Sources for this page

Verify at the official NPI Registry.