Provider Demographics
NPI:1528006947
Name:THE WATERS OF NEW CASTLE, LLC
Entity Type:Organization
Organization Name:THE WATERS OF NEW CASTLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-449-1900
Mailing Address - Street 1:1000 N 16TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4319
Mailing Address - Country:US
Mailing Address - Phone:765-521-1420
Mailing Address - Fax:765-521-1367
Practice Address - Street 1:1000 N 16TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-521-1420
Practice Address - Fax:765-521-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000201-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000381426OtherANTHEM BCBS
IN100267910CMedicaid
IN000000381426OtherANTHEM BCBS
IN000000391204OtherANTHEM OT
IN000000391205OtherANTHEM PT
IN155304Medicare Oscar/Certification
IN100267910CMedicaid