Organization
LAKEBRIDGE A WATERS COMMUNITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOISHE GUBIN (MEMBER)
(708) 449-1900
Entity
Organization
Contact information
Practice address
115 WOODLAWN DR, JOHNSON CITY, TN 37604-5978
(423) 975-0095
(423) 928-0358
Mailing address
115 WOODLAWN DR, JOHNSON CITY, TN 37604-5978
(423) 975-0095
(423) 928-0358
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
08/02/2016
Last updated
08/02/2016
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