Organization
THE WATERS OF SCOTTSBURG, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY V. KEMPER (CHIEF FINANCIAL OFFICER)
(317) 598-9496
Entity
Organization
Contact information
Practice address
1350 N. TODD DRIVE, SCOTTSBURG, IN 47170-7755
(812) 752-5663
(812) 752-9853
Mailing address
9785 CROSSPOINT BLVD., SUITE 104, INDIANAPOLIS, IN 40256-3321
(317) 598-9496
(317) 598-9467
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
08-000478-1
IN
314000000X
Skilled Nursing Facility
Primary
060004783
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100290430
—
IN
05
—
100290430E
—
IN
Enumeration date
12/18/2006
Last updated
03/23/2009
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