NPIMap

Organization Active NPI

Waters of Memphis a Rehabilitation & Nursing Center

  • Skilled Nursing Facility
  • Memphis, TN
National Provider Identifier
1568039436
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WATERS OF MEMPHIS A REHABILITATION & NURSING CENTER
Practice address
6500 Kirby Gate Blvd
Memphis, TN 38119-2673
Phone
(901) 752-0772
NPI assigned
Jun 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

6500 Kirby Gate Blvd
Memphis, TN 38119-2673

Mailing address

240 Fencl LN
Hillside, IL 60162-2067
Phone (708) 449-1900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220125000533 TN Part A Provider - Skilled Nursing Facility 4486046430 Practice locations: Memphis, TN

Skilled nursing facility certification: CCN 445522

Legal name
WATERS OF MEMPHIS A REHABILITATION & NURSING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 11, 2016
Last certification
Sep 14, 2023
Beds
90
Ownership / control type
Individual
Multi-facility organization
Infinity Health
Most recent change of ownership
Jul 1, 2021
Organization structure
LLCProprietary
Enrollment address
6500 Kirby Gate Blvd
Memphis, TN 38119-2673
Nursing home name
WATERS OF MEMPHIS A REHABILITATION & NURSING CTR
Affiliated entity
INFINITY HEALTHCARE CONSULTING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Waters of Memphis a Rehabilitation & Nursing CtrCCN 445522 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Apr 11, 2016
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9082.9 residents per day on average
Chain
Infinity Healthcare Consulting69 facilities in the chain
Penalties (3 years)
1Fines totaling $5,293

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
44D2094146Waters of Memphis6500 Kirby Gate Blvd, Memphis, TN 38119Certificate of waiverApr 12, 2027

National Provider Directory

National Provider Directory

Locations

6500 Kirby Gate Blvd
Memphis, TN 38119
Phone (901) 230-2232

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 5% Or Greater Direct Ownership Interest Jul 1, 2021 50%
Michael Blisko Individual 5% Or Greater Direct Ownership InterestManager Jul 1, 2021 50%
Kristian Carr Individual W-2 Managing EmployeeAd; Sep 12, 2022

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.

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": "1623110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623110400000",
    "number": "1568039436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 FENCL LN",
            "city": "HILLSIDE",
            "state": "IL",
            "postal_code": "601622067",
            "telephone_number": "708-449-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 KIRBY GATE BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381192673",
            "telephone_number": "901-752-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERS OF MEMPHIS A REHABILITATION & NURSING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-08",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "BLISKO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "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 Memphis, TN

Sources for this page

Verify at the official NPI Registry.