Organization
THE WATERS OF YORKTOWN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN SORSCHER (CFO)
(708) 449-1900
Entity
Organization
Contact information
Practice address
2000 S. ANDREWS ROAD, YORKTOWN, IN 47396-6812
(765) 759-7740
(765) 759-7131
Mailing address
240 FENCL LANE, HILLSIDE, IL 60162-2067
(708) 449-1900
(708) 449-1500
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
05-000143-1
IN
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000381429
ANTHEM BCBS
IN
01
—
000000391196
ANTHEM ST
IN
01
—
000000391198
ANTHEM PT
IN
01
—
000000391199
ANTHEM OT
IN
05
—
100283890C
—
IN
01
—
5584850001
DMERC REGION B SUPPLIER#
IN
Enumeration date
06/04/2006
Last updated
09/20/2012
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