Provider Demographics
NPI:1013664945
Name:SPRINGWATER AT WATERMAN VILLAGE
Entity Type:Organization
Organization Name:SPRINGWATER AT WATERMAN VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RISK MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:VANSYCKEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:352-383-0051
Mailing Address - Street 1:250 BROOKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-9559
Mailing Address - Country:US
Mailing Address - Phone:352-383-0051
Mailing Address - Fax:
Practice Address - Street 1:2858 LIGHTHOUSE SHORE WAY
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757
Practice Address - Country:US
Practice Address - Phone:352-383-0051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WATERMAN COMMUNITIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility