# WATERS OF LEBANON LLC

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

## Provider details

- **NPI number:** 1629590310
- **Authorized official:** MOISHE GUBIN (OWNER)
- **Authorized official phone:** (708) 449-1900

## Contact information

- **Practice address:** 1585 PERRY WORTH RD, LEBANON, IN 46052-9635
- **Practice address phone:** (765) 482-6391
- **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 | — | — | Yes |

## Other

- **Enumeration date:** 07/13/2017
- **Last updated:** 07/13/2017