# WATERS OF CLINTON LLC

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

## Provider details

- **NPI number:** 1336693357
- **Authorized official:** MICHAEL BLISKO (CEO)
- **Authorized official phone:** (708) 449-1900

## Contact information

- **Practice address:** 220 LONGMIRE RD, CLINTON, TN 37716-7338
- **Practice address phone:** (865) 457-6925
- **Mailing address:** 220 LONGMIRE RD, CLINTON, TN 37716-7338
- **Mailing address phone:** (865) 457-6925

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/08/2016
- **Last updated:** 04/06/2023