NPIMap

Organization Active NPI

Waters of Bristol a Rehabilitation & Nursing Center LLC

  • Skilled Nursing Facility
  • Bristol, TN
National Provider Identifier
1932776804
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WATERS OF BRISTOL A REHABILITATION & NURSING CENTER LLC
Practice address
2830 Highway 394
Bristol, TN 37617
Phone
(423) 274-6191
NPI assigned
Jun 8, 2021
Last updated
Jun 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

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

Authorized official

Name
Michael Blisko
Title
Owner
Phone
(708) 449-1900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

2830 Highway 394
Bristol, TN 37617

Mailing address

240 Fencl LN
Hillside, IL 60162-2067
Phone (708) 449-1900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221011001283 TN Part A Provider - Skilled Nursing Facility 1456737741 Practice locations: Blountville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932776804. Details of each certification follow.

Skilled nursing facility certification: CCN 445530

Legal name
WATERS OF BRISTOL A REHABILITATION & NURSING CENTER LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 6, 2018
Last certification
Jun 12, 2024
Beds
120
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
2830 Highway 394
Blountville, TN 37617-5577
Nursing home name
WATERS OF BRISTOL A REHABILITATION AND NURSING
Affiliated entity
INFINITY HEALTHCARE CONSULTING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Waters of Bristol a Rehabilitation and NursingCCN 445530 · All quality measures
Overall star rating
4 of 5
Health inspections
5 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 6, 2018
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120112.4 residents per day on average
Chain
Infinity Healthcare Consulting69 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2133680Waters of Bristol, a Rehabilitation &2830 Highway 394, Bristol, TN 37617Certificate of waiverJul 17, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

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 5% Or Greater Direct Ownership Interest Jul 1, 2021 50%
Michael Blisko Individual 5% Or Greater Direct Ownership InterestManager Jul 1, 2021 50%
Cody Clark Individual W-2 Managing EmployeeAd; Oct 1, 2021

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 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

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": "1623110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623110400000",
    "number": "1932776804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 FENCL LN",
            "city": "HILLSIDE",
            "state": "IL",
            "postal_code": "601622067",
            "telephone_number": "708-449-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2830 HIGHWAY 394",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "37617",
            "telephone_number": "423-274-6191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERS OF BRISTOL A REHABILITATION & NURSING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-08",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "BLISKO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "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": []
}

Other providers in Bristol, TN

Sources for this page

Verify at the official NPI Registry.