Watermark Senior Living Inc

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

WATERMARK SENIOR LIVING INC

Practice address

5761 Conner Rd
Flowery Branch, GA 30542-2717

Phone

(678) 910-1245

NPI assigned

Apr 22, 2022

Organization subpart

No

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

Authorized official

Name

Julia Kern

Title

Vice-President

Phone

(678) 910-1245

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1650585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650585600000",
    "number": "1982348330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 MCLEOD DR STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891212257",
            "telephone_number": "678-910-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5761 CONNER RD",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305422717",
            "telephone_number": "678-910-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERMARK SENIOR LIVING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-22",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A",
        "authorized_official_last_name": "KERN",
        "authorized_official_first_name": "JULIA",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "678-910-1245"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003125678B",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://us02web.zoom.us/j/6258713315?pwd=dXZtbW5wc3JIRVVFYi8rTHcxcXNldz09",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "file attachment",
            "address_1": "5761 Conner Rd",
            "city": "Flowery Branch",
            "state": "GA",
            "country_code": "US",
            "postal_code": "305422717",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; 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.