Waters of Lebanon LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

WATERS OF LEBANON LLC

Practice address

1585 Perry Worth Rd
Lebanon, IN 46052-9635

Phone

(765) 482-6391

NPI assigned

Jul 13, 2017

Organization subpart

No

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

Authorized official

Name

Moishe Gubin

Title

Owner

Phone

(708) 449-1900

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1499904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499904000000",
    "number": "1629590310",
    "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": "1585 PERRY WORTH RD",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460529635",
            "telephone_number": "765-482-6391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERS OF LEBANON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-13",
        "last_updated": "2017-07-13",
        "status": "A",
        "authorized_official_last_name": "GUBIN",
        "authorized_official_first_name": "MOISHE",
        "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": []
}

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• Leah Warner, PHARMD
• Denasia Warren, RBT
• Paul David Warrick, MD
• Amy Marie Watts, LCSW
• Landon Wells
• Paul Frederick Werry II, DDS
• Jayla Wesley, RBT
• Amelia Ann West, LMHC

• Skilled Nursing Facility in Lebanon, IN
• Providers in Lebanon, 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 Jul 13, 2017; 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.