MEDICARE: THE WATERS OF CASTLETON SKILLED NURSING FACILITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1174231922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WATERS OF CASTLETON SKILLED NURSING FACILITY LLC

Provider Business Mailing Address
First Line	:	240 FENCL LN
Second Line	:
City	:	HILLSIDE
State	:	IL
Zip	:	60162-2067
Country	:	US
Telephone Number	:	708-449-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 CLEARVISTA PL
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3700
Country	:	US
Telephone Number	:	317-841-4187
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JEFFREY SAX
Credential	:
Telephone Number	:	219-898-5705

Provider Enumeration Date	:	11/10/2022
Last Update Date	:	11/10/2022

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