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General NPI Number Information
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NPI Number | 1275767667
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Entity Type | Organization
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Legal Business Name | WATERS OF SCOTTSBURG II
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Dates
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Enumeration Date | 05/13/2009
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 1350 N. TODD DR.
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City | SCOTTSBURG
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State | IN
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Zip | 47170-7755
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Country | US
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Telephone | 812-752-5663
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Fax | 812-752-9853
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Provider Business Mailing Address
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Address Line | 240 FENCL LANE
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City | HILLSIDE
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State | IL
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Zip | 60162-2067
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Country | US
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Telephone | 708-449-1900
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Fax | 708-449-1500
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Authorized Official
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Title or Position | CFO
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Name | ALAN SORSCHER
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Credential |
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Telephone | 708-449-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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