# THE WATERS OF PRINCETON, LLC

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

## Provider details

- **NPI number:** 1871531459
- **Authorized official:** MR. MICHAEL BLISKO (CEO)
- **Authorized official phone:** (708) 449-1900

## Contact information

- **Practice address:** 1020 W VINE ST, PRINCETON, IN 47670-1164
- **Practice address phone:** (812) 385-5238
- **Practice address fax:** (812) 386-7471
- **Mailing address:** 1020 W VINE ST, PRINCETON, IN 47670-1164
- **Mailing address phone:** (812) 385-5238
- **Mailing address fax:** (812) 386-7471

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 05-000175-1 | IN | Yes |

## Other

- **Enumeration date:** 06/03/2006
- **Last updated:** 05/17/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000381545 | ANTHEM BCBS | IN |
| 01 | — | 000000476417 | ANTHEM ST | IN |
| 01 | — | 000000476418 | ANTHEM PT | IN |
| 01 | — | 000000476419 | ANTHEM OT | IN |
| 05 | — | 100274440C | — | IN |