Basic Information
| Provider Information | |||||||||
| NPI: | 1992372866 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WATERS OF SWEETWATER A REHABILITATION & NURSING CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 FENCL LN | ||||||||
| Address2: | |||||||||
| City: | HILLSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601622067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084491900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 978 HIGHWAY 11 S | ||||||||
| Address2: | |||||||||
| City: | SWEETWATER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378745746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233376631 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2021 | ||||||||
| LastUpdateDate: | 06/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | BLISKO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7082401518 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.