# THE WATERS OF DUNELAND, LLC

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

## Provider details

- **NPI number:** 1881631240
- **Authorized official:** MR. MICHAEL BLISKO (COO)
- **Authorized official phone:** (708) 449-1900

## Contact information

- **Practice address:** 110 BEVERLY DR, CHESTERTON, IN 46304-9368
- **Practice address phone:** (219) 926-8387
- **Practice address fax:** (219) 929-1776
- **Mailing address:** 110 BEVERLY DR, CHESTERTON, IN 46304-9368
- **Mailing address phone:** (219) 926-8387
- **Mailing address fax:** (219) 395-1510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 05-000150-1 | IN | Yes |

## Other

- **Enumeration date:** 06/02/2006
- **Last updated:** 02/19/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000381420 | ANTHEM BCBS | IN |
| 01 | — | 000000476402 | ANTHEM OT | IN |
| 01 | — | 000000476403 | ANTHEM PT | IN |
| 01 | — | 000000476404 | ANTHEM ST | IN |
| 05 | — | 100267000C | — | IN |
| 01 | — | 5584660001 | DMERC REGION B SUPPLIER\# | IN |