Provider Demographics
NPI:1205389657
Name:THE WATERS OF ROAN HIGHLANDS LLC
Entity Type:Organization
Organization Name:THE WATERS OF ROAN HIGHLANDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOISHE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-449-1900
Mailing Address - Street 1:146 BUCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROAN MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37687-3497
Mailing Address - Country:US
Mailing Address - Phone:423-772-0161
Mailing Address - Fax:423-772-3481
Practice Address - Street 1:146 BUCK CREEK RD
Practice Address - Street 2:
Practice Address - City:ROAN MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37687-3497
Practice Address - Country:US
Practice Address - Phone:423-772-0161
Practice Address - Fax:423-772-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility