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General NPI Number Information
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NPI Number | 1518411586
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Entity Type | Organization
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Legal Business Name | WATERS OF GALLATIN LLC
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 555 E BLEDSOE ST
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City | GALLATIN
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State | TN
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Zip | 37066-3003
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Country | US
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Telephone | 615-502-0599
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Fax |
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Provider Business Mailing Address
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Address Line | 555 E BLEDSOE ST
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City | GALLATIN
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State | TN
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Zip | 37066-3003
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Country | US
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Telephone | 615-502-0599
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MICHAEL BLISKO
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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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