NPIMap

Organization Active NPI

Waters of Sweetwater a Rehabilitation & Nursing Center LLC

  • Skilled Nursing Facility
  • Sweetwater, TN
National Provider Identifier
1992372866
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WATERS OF SWEETWATER A REHABILITATION & NURSING CENTER LLC
Practice address
978 Highway 11 S
Sweetwater, TN 37874-5746
Phone
(423) 337-6631
NPI assigned
Jun 8, 2021
Last updated
Jun 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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

Authorized official

Name
Michael Blisko
Title
Manager
Phone
(708) 240-1518

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

978 Highway 11 S
Sweetwater, TN 37874-5746

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
O20220125000373 TN Part A Provider - Skilled Nursing Facility 5890187843 Practice locations: Sweetwater, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992372866. Details of each certification follow.

Skilled nursing facility certification: CCN 445456

Legal name
WATERS OF SWEETWATER A REHABILITATION & NURSING CENTER LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 1, 2002
Last certification
May 15, 2024
Beds
90
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Infinity LLC
Organization structure
LLCProprietary
Enrollment address
978 Highway 11 S
Sweetwater, TN 37874-5746
Nursing home name
WATERS OF SWEETWATER A REHABILITATION & NURSING
Affiliated entity
INFINITY HEALTHCARE CONSULTING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Waters of Sweetwater a Rehabilitation & NursingCCN 445456 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 1, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9068.8 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
44D0996082Waters of Sweetwater, a Rehabilitation &978 Highway 11 South, Sweetwater, TN 37874Certificate of waiverFeb 7, 2028

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%
Rita Griffin Individual W-2 Managing EmployeeAd; Mar 27, 2024
Michael Blisko Individual 5% Or Greater Direct Ownership InterestManager Jul 1, 2021 50%

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 2

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 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": "1623110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655164800000",
    "number": "1992372866",
    "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": "978 HIGHWAY 11 S",
            "city": "SWEETWATER",
            "state": "TN",
            "postal_code": "378745746",
            "telephone_number": "423-337-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERS OF SWEETWATER A REHABILITATION & NURSING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-08",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "BLISKO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "708-240-1518"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sweetwater, TN

Sources for this page

Verify at the official NPI Registry.