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Organization
THE WATERS OF SCOTTSBURG, LLC
Active
Organization
THE WATERS OF SCOTTSBURG, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY V. KEMPER (CHIEF FINANCIAL OFFICER)
(317) 598-9496
Entity
Organization
Contact information
Practice address
1350 N. TODD DRIVE, SCOTTSBURG, IN 47170-7755
(812) 752-5663
(812) 752-9853
Mailing address
9785 CROSSPOINT BLVD., SUITE 104, INDIANAPOLIS, IN 40256-3321
(317) 598-9496
(317) 598-9467
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
08-000478-1
IN
314000000X
Skilled Nursing Facility
Primary
060004783
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100290430
—
IN
05
—
100290430E
—
IN
Enumeration date
12/18/2006
Last updated
03/23/2009
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