Organization
THE WATERS OF HUNTINGBURG, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BLISKO (COO)
(708) 449-1900
Entity
Organization
Contact information
Practice address
1712 N LELAND DR, HUNTINGBURG, IN 47542-9348
(812) 683-4090
(812) 683-2305
Mailing address
1712 N LELAND DR, HUNTINGBURG, IN 47542-9348
(812) 683-4090
(812) 683-2305
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
05-000122-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000381425
ANTHEM BCBS
IN
01
—
000000391200
ANTHEM OT
IN
01
—
000000391202
ANTHEM PT
IN
01
—
000000391203
ANTHEM ST
IN
05
—
100290560C
—
IN
01
—
5586190001
DMERC REGION B SUPPLIER#
IN
Enumeration date
06/03/2006
Last updated
05/17/2012
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