Provider Demographics
NPI:1497130181
Name:WATERS HOMECARE
Entity Type:Organization
Organization Name:WATERS HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-480-4456
Mailing Address - Street 1:45124 EWING PARK RD APT 101
Mailing Address - Street 2:
Mailing Address - City:CALLAHAN
Mailing Address - State:FL
Mailing Address - Zip Code:32011-3838
Mailing Address - Country:US
Mailing Address - Phone:904-480-4456
Mailing Address - Fax:
Practice Address - Street 1:45124 EWING PARK RD APT 101
Practice Address - Street 2:
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-3838
Practice Address - Country:US
Practice Address - Phone:904-480-4456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320916251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health