Waters of Fort Smith LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

WATERS OF FORT SMITH LLC

Practice address

5301 Wheeler Ave
Fort Smith, AR 72901-8339

Phone

(479) 646-3454

NPI assigned

Sep 20, 2018

Organization subpart

No

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

Authorized official

Name

Moishe Gubin

Title

Manager

Phone

(708) 449-1900

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1537401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596585600000",
    "number": "1922582477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 WHEELER AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729018339",
            "telephone_number": "479-646-3454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 WHEELER AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729018339",
            "telephone_number": "479-646-3454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERS OF FORT SMITH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-20",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A",
        "authorized_official_last_name": "GUBIN",
        "authorized_official_first_name": "MOISHE",
        "authorized_official_title_or_position": "MANAGER",
        "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": []
}

• Taylor Warren
• Lynn C Washington, LPC
• Melida S Washington, LPN
• Steven Sanders Washington, LPC
• Dominique Michele Waterbury
• Krysten Anne Watson
• Robyn Watson, MHPP
• Melissa R Watts, SLP
• Mark A Wear, PHARM D.
• Shawnda Elaine Wear, LPC

• Skilled Nursing Facility in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Skilled Nursing Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; 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.