The Waters of Princeton, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

05-000175-1 Issued in IN

Legal business name

THE WATERS OF PRINCETON, LLC

Practice address

1020 W Vine St
Princeton, IN 47670-1164

Phone

(812) 385-5238

Fax

(812) 386-7471

NPI assigned

Jun 3, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Michael Blisko

Title

Ceo

Phone

(708) 449-1900

Specialties & licenses 1

Addresses

Other identifiers 5

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337212800000",
    "number": "1871531459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 W VINE ST",
            "city": "PRINCETON",
            "state": "IN",
            "postal_code": "476701164",
            "telephone_number": "812-385-5238",
            "fax_number": "812-386-7471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 W VINE ST",
            "city": "PRINCETON",
            "state": "IN",
            "postal_code": "476701164",
            "telephone_number": "812-385-5238",
            "fax_number": "812-386-7471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WATERS OF PRINCETON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2012-05-17",
        "status": "A",
        "authorized_official_last_name": "BLISKO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-449-1900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IN",
            "license": "05-000175-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000381545",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100274440C",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PT",
            "identifier": "000000476418",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM OT",
            "identifier": "000000476419",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM ST",
            "identifier": "000000476417",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Princeton, IN
• Providers in Princeton, 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 May 17, 2012; 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.