The Waters of Scottsburg, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

060004783 Issued in IN

Legal business name

THE WATERS OF SCOTTSBURG, LLC

Practice address

1350 N. Todd Drive
Scottsburg, IN 47170-7755

Phone

(812) 752-5663

Fax

(812) 752-9853

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jerry V. Kemper

Title

Chief Financial Officer

Phone

(317) 598-9496

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237766400000",
    "number": "1851454573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9785 CROSSPOINT BLVD.",
            "address_2": "SUITE 104",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "402563321",
            "telephone_number": "317-598-9496",
            "fax_number": "317-598-9467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 N. TODD DRIVE",
            "city": "SCOTTSBURG",
            "state": "IN",
            "postal_code": "471707755",
            "telephone_number": "812-752-5663",
            "fax_number": "812-752-9853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WATERS OF SCOTTSBURG, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2009-03-23",
        "status": "A",
        "authorized_official_last_name": "KEMPER",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "317-598-9496",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IN",
            "license": "08-000478-1",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IN",
            "license": "060004783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100290430",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100290430E",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Scottsburg, IN
• Providers in Scottsburg, 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 Mar 23, 2009; 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.