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NPI Code Detail

MEDICARE: WATERMARK LOGAN, LLC

MEDICARE: WATERMARK LOGAN, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility127502PA

General Provider Information

NPI Number : 1679015697
Entity Type Code : Organization
Provider Name (Legal Business Name) : WATERMARK LOGAN, LLC
Provider Business Mailing Address
First Line : 2020 W RUDASILL RD
Second Line :
City : TUCSON
State : AZ
Zip : 85704-7800
Country : US
Telephone Number : 520-797-4000
Fax Number : 520-797-7757
Provider Business Practice Location Address
First Line : 2 FRANKLIN TOWN BLVD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-1238
Country : US
Telephone Number : 215-563-1800
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : GRETA FRAZIER
Credential :
Telephone Number : 520-797-4000
Provider Enumeration Date : 11/08/2016
Last Update Date : 11/08/2016

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