# AGAPE REHABILITATION & NURSING CENTER A WATERS COMMUNITY LLC

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

## Provider details

- **NPI number:** 1548837511
- **Authorized official:** MICHAEL BLISKO (OWNER)
- **Authorized official phone:** (708) 449-1900

## Contact information

- **Practice address:** 505 N ROAN ST, JOHNSON CITY, TN 37601-4740
- **Practice address phone:** (423) 975-2000
- **Mailing address:** 240 FENCL LN, HILLSIDE, IL 60162-2067
- **Mailing address phone:** (708) 449-1900

## Taxonomy

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

## Other

- **Enumeration date:** 06/08/2021
- **Last updated:** 11/10/2021