Healthcare Provider Details

I. General information

NPI: 1891568804
Provider Name (Legal Business Name): WATERS OF GAINESBORO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 N GRUNDY QUARLES HWY
GAINESBORO TN
38562-6001
US

IV. Provider business mailing address

1340 N GRUNDY QUARLES HWY
GAINESBORO TN
38562-6001
US

V. Phone/Fax

Practice location:
  • Phone: 931-268-0291
  • Fax:
Mailing address:
  • Phone: 931-268-0291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY SAX
Title or Position: MANAGER
Credential:
Phone: 269-281-4200