Provider Demographics
NPI:1578894671
Name:WATCO COMMUNITIES, LLC
Entity Type:Organization
Organization Name:WATCO COMMUNITIES, LLC
Other - Org Name:MOUNTAINBROOK VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-428-2445
Mailing Address - Street 1:700 MARKHILL DR
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-4023
Mailing Address - Country:US
Mailing Address - Phone:865-428-2445
Mailing Address - Fax:865-428-2507
Practice Address - Street 1:700 MARKHILL DR
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-4023
Practice Address - Country:US
Practice Address - Phone:865-428-2445
Practice Address - Fax:865-428-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000013310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility