Healthcare Provider Details

I. General information

NPI: 1568039436
Provider Name (Legal Business Name): WATERS OF MEMPHIS A REHABILITATION & NURSING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 KIRBY GATE BLVD
MEMPHIS TN
38119-2673
US

IV. Provider business mailing address

240 FENCL LN
HILLSIDE IL
60162-2067
US

V. Phone/Fax

Practice location:
  • Phone: 901-752-0772
  • Fax:
Mailing address:
  • Phone: 708-449-1900
  • 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: MICHAEL BLISKO
Title or Position: OWNER
Credential:
Phone: 708-449-1900