# THE WATERS OF HUNTINGBURG, LLC

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

## Provider details

- **NPI number:** 1306884994
- **Authorized official:** MR. MICHAEL BLISKO (COO)
- **Authorized official phone:** (708) 449-1900

## Contact information

- **Practice address:** 1712 N LELAND DR, HUNTINGBURG, IN 47542-9348
- **Practice address phone:** (812) 683-4090
- **Practice address fax:** (812) 683-2305
- **Mailing address:** 1712 N LELAND DR, HUNTINGBURG, IN 47542-9348
- **Mailing address phone:** (812) 683-4090
- **Mailing address fax:** (812) 683-2305

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 05-000122-1 | IN | Yes |

## Other

- **Enumeration date:** 06/03/2006
- **Last updated:** 05/17/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000381425 | ANTHEM BCBS | IN |
| 01 | — | 000000391200 | ANTHEM OT | IN |
| 01 | — | 000000391202 | ANTHEM PT | IN |
| 01 | — | 000000391203 | ANTHEM ST | IN |
| 05 | — | 100290560C | — | IN |
| 01 | — | 5586190001 | DMERC REGION B SUPPLIER\# | IN |