NPIMap

Organization Active NPI

Waters of Gainesboro LLC

  • Skilled Nursing Facility
  • Gainesboro, TN
National Provider Identifier
1891568804
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WATERS OF GAINESBORO LLC
Practice address
1340 N Grundy Quarles Hwy
Gainesboro, TN 38562-6001
Phone
(931) 268-0291
NPI assigned
Nov 1, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Authorized official

Name
Jeffrey Sax
Title
Manager
Phone
(269) 281-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1340 N Grundy Quarles Hwy
Gainesboro, TN 38562-6001

Mailing address

1340 N Grundy Quarles Hwy
Gainesboro, TN 38562-6001
Phone (931) 268-0291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240405003848 TN Part A Provider - Skilled Nursing Facility 0042658205 Practice locations: Gainesboro, TN

Skilled nursing facility certification: CCN 445272

Legal name
WATERS OF GAINESBORO LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 24, 1991
Last certification
Feb 5, 2025
Beds
80
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Infinity
Organization structure
LLCProprietary
Enrollment address
1340 N Grundy Quarles Hwy
Gainesboro, TN 38562-6001
Nursing home name
MABRY HEALTH CARE
Affiliated entity
INFINITY HEALTHCARE CONSULTING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Mabry Health CareCCN 445272
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 24, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8075.3 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 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gubin Enterprises Limited Partnership Organization, South Bend, IN For-profit 5% Or Greater Direct Ownership Interest Nov 1, 2023 50%
Adp of the SNF Nov 1, 2023
Michael Blisko Individual 5% Or Greater Direct Ownership Interest Nov 1, 2023 50%
Managing Control - Governing BodyManager Nov 1, 2023
Trustee of the SNF Nov 1, 2023
Joseph Pomerantsev Individual Trustee of the SNF Nov 1, 2023
Rita Crabtree Individual Operational/Managerial Control Oct 24, 2024
Adp of the SNF Oct 28, 2024
Infinity Healthcare Consulting LLC Organization, Hillside, IL LLC, Consulting firm, For-profit Adp of the SNF Nov 1, 2023
1340 North Grundy Quales Highway LLC Organization, Gainesboro, TN LLC, For-profit Adp of the SNF Nov 1, 2023

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": "1698796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1891568804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 N GRUNDY QUARLES HWY",
            "city": "GAINESBORO",
            "state": "TN",
            "postal_code": "385626001",
            "telephone_number": "931-268-0291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 N GRUNDY QUARLES HWY",
            "city": "GAINESBORO",
            "state": "TN",
            "postal_code": "385626001",
            "telephone_number": "931-268-0291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERS OF GAINESBORO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-01",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "SAX",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "269-281-4200"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesboro, TN

Sources for this page

Verify at the official NPI Registry.