NPIMap

Organization Active NPI

Waters of McKenzie a Rehabilitation & Nursing Center LLC

  • Skilled Nursing Facility
  • MC Kenzie, TN
National Provider Identifier
1659948529
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WATERS OF MCKENZIE A REHABILITATION & NURSING CENTER LLC
Practice address
14510 Highway 79
MC Kenzie, TN 38201-7824
Phone
(731) 352-5317
NPI assigned
Jun 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

14510 Highway 79
MC Kenzie, TN 38201-7824

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
O20220426000317 TN Part A Provider - Skilled Nursing Facility 6103213970 Practice locations: MC Kenzie, TN

Skilled nursing facility certification: CCN 445357

Legal name
WATERS OF MCKENZIE A REHABILITATION & NURSING CENTER LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1995
Last certification
Apr 17, 2025
Beds
66
Ownership / control type
Individual
Most recent change of ownership
Jul 1, 2021
Organization structure
LLCProprietary
Enrollment address
14510 Highway 79
MC Kenzie, TN 38201-7824
Nursing home name
WATERS OF MCKENZIE A REHABILITATION & NURSING CTR
Affiliated entity
INFINITY HEALTHCARE CONSULTING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Waters of McKenzie a Rehabilitation & Nursing CtrCCN 445357
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Jul 1, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6643.1 residents per day on average
Chain
Infinity Healthcare Consulting69 facilities in the chain

Processed by Care Compare on Aug 1, 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
Donna Caldwell Individual W-2 Managing EmployeeAd; Jun 5, 2024
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%

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 1

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": "1652832000000",
    "number": "1659948529",
    "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": "14510 HIGHWAY 79",
            "city": "MC KENZIE",
            "state": "TN",
            "postal_code": "382017824",
            "telephone_number": "731-352-5317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERS OF MCKENZIE A REHABILITATION & NURSING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-08",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "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 MC Kenzie, TN

Sources for this page

Verify at the official NPI Registry.