Watermark Park Lane, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

WATERMARK PARK LANE, LLC

Practice address

1615 E Boot Rd
West Chester, PA 19380-6001

Phone

(484) 714-0490

NPI assigned

Sep 23, 2020

Organization subpart

No

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

Authorized official

Name

David Freshwater

Title

Authorized Official

Phone

(520) 797-4000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1600819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1376150409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 W RUDASILL RD",
            "address_2": "C/O LICENSING",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85704",
            "telephone_number": "520-392-7624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 E BOOT RD",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193806001",
            "telephone_number": "484-714-0490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERMARK PARK LANE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-23",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "FRESHWATER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "520-797-4000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; 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.