Organization
THE WATERS OF PRINCETON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BLISKO (CEO)
(708) 449-1900
Entity
Organization
Contact information
Practice address
1020 W VINE ST, PRINCETON, IN 47670-1164
(812) 385-5238
(812) 386-7471
Mailing address
1020 W VINE ST, PRINCETON, IN 47670-1164
(812) 385-5238
(812) 386-7471
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
05-000175-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000381545
ANTHEM BCBS
IN
01
—
000000476417
ANTHEM ST
IN
01
—
000000476418
ANTHEM PT
IN
01
—
000000476419
ANTHEM OT
IN
05
—
100274440C
—
IN
Enumeration date
06/03/2006
Last updated
05/17/2012
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