Organization
THE WATERS OF DUNELAND, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BLISKO (COO)
(708) 449-1900
Entity
Organization
Contact information
Practice address
110 BEVERLY DR, CHESTERTON, IN 46304-9368
(219) 926-8387
(219) 929-1776
Mailing address
110 BEVERLY DR, CHESTERTON, IN 46304-9368
(219) 926-8387
(219) 395-1510
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
05-000150-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000381420
ANTHEM BCBS
IN
01
—
000000476402
ANTHEM OT
IN
01
—
000000476403
ANTHEM PT
IN
01
—
000000476404
ANTHEM ST
IN
05
—
100267000C
—
IN
01
—
5584660001
DMERC REGION B SUPPLIER#
IN
Enumeration date
06/02/2006
Last updated
02/19/2014
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