The Waters of Duneland, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

05-000150-1 Issued in IN

Legal business name

THE WATERS OF DUNELAND, LLC

Practice address

110 Beverly Dr
Chesterton, IN 46304-9368

Phone

(219) 926-8387

Fax

(219) 929-1776

NPI assigned

Jun 2, 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

Coo

Phone

(708) 449-1900

Specialties & licenses 1

Addresses

Other identifiers 6

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392768000000",
    "number": "1881631240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BEVERLY DR",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049368",
            "telephone_number": "219-926-8387",
            "fax_number": "219-395-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BEVERLY DR",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049368",
            "telephone_number": "219-926-8387",
            "fax_number": "219-929-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WATERS OF DUNELAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2014-02-19",
        "status": "A",
        "authorized_official_last_name": "BLISKO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "708-449-1900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IN",
            "license": "05-000150-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM OT",
            "identifier": "000000476402",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000381420",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM ST",
            "identifier": "000000476404",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PT",
            "identifier": "000000476403",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC REGION B SUPPLIER#",
            "identifier": "5584660001",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100267000C",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Chesterton, IN
• Providers in Chesterton, 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 Feb 19, 2014; 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.