# THE WATERS OF YORKTOWN, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275572646
- **Authorized official:** ALAN SORSCHER (CFO)
- **Authorized official phone:** (708) 449-1900

## Contact information

- **Practice address:** 2000 S. ANDREWS ROAD, YORKTOWN, IN 47396-6812
- **Practice address phone:** (765) 759-7740
- **Practice address fax:** (765) 759-7131
- **Mailing address:** 240 FENCL LANE, HILLSIDE, IL 60162-2067
- **Mailing address phone:** (708) 449-1900
- **Mailing address fax:** (708) 449-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 05-000143-1 | IN | — |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 06/04/2006
- **Last updated:** 09/20/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000381429 | ANTHEM BCBS | IN |
| 01 | — | 000000391196 | ANTHEM ST | IN |
| 01 | — | 000000391198 | ANTHEM PT | IN |
| 01 | — | 000000391199 | ANTHEM OT | IN |
| 05 | — | 100283890C | — | IN |
| 01 | — | 5584850001 | DMERC REGION B SUPPLIER\# | IN |