Organization
THE WATERS OF NEW CASTLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BLISKO (CEO)
(708) 449-1900
Entity
Organization
Contact information
Practice address
1000 N 16TH ST, 3RD FLOOR, NEW CASTLE, IN 47362-4319
(765) 521-1420
(765) 521-1367
Mailing address
1000 N 16TH ST, 3RD FLOOR, NEW CASTLE, IN 47362-4319
(765) 521-1420
(765) 521-1367
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
05-000201-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000381426
ANTHEM BCBS
IN
01
—
000000381426
ANTHEM BCBS
—
01
—
000000391204
ANTHEM OT
IN
01
—
000000391205
ANTHEM PT
IN
05
—
100267910C
—
IN
Enumeration date
06/04/2006
Last updated
05/17/2012
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