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Organization
THE WATERS OF NEW CASTLE, LLC
Active
Organization
THE WATERS OF NEW CASTLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BLISKO (CEO)
(708) 449-1900
Entity
Organization
Contact information
Practice address
1000 N 16TH ST, 3RD FLOOR, NEW CASTLE, IN 47362-4319
(765) 521-1420
(765) 521-1367
Mailing address
1000 N 16TH ST, 3RD FLOOR, NEW CASTLE, IN 47362-4319
(765) 521-1420
(765) 521-1367
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
05-000201-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000381426
ANTHEM BCBS
IN
01
—
000000391204
ANTHEM OT
IN
01
—
000000391205
ANTHEM PT
IN
05
—
100267910C
—
IN
Enumeration date
06/04/2006
Last updated
05/17/2012
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