Healthcare Provider Details

I. General information

NPI: 1275572646
Provider Name (Legal Business Name): THE WATERS OF YORKTOWN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S. ANDREWS ROAD
YORKTOWN IN
47396-6812
US

IV. Provider business mailing address

240 FENCL LANE
HILLSIDE IL
60162-2067
US

V. Phone/Fax

Practice location:
  • Phone: 765-759-7740
  • Fax: 765-759-7131
Mailing address:
  • Phone: 708-449-1900
  • Fax: 708-449-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05-000143-1
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ALAN SORSCHER
Title or Position: CFO
Credential:
Phone: 708-449-1900