Provider Demographics
NPI:1043928807
Name:THE WATERS OF LAGRANGE SKILLED NURSING FACILITY LLC
Entity type:Organization
Organization Name:THE WATERS OF LAGRANGE SKILLED NURSING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-898-5705
Mailing Address - Street 1:240 FENCL LN
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-2067
Mailing Address - Country:US
Mailing Address - Phone:708-449-1900
Mailing Address - Fax:
Practice Address - Street 1:787 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-1111
Practice Address - Country:US
Practice Address - Phone:260-463-2172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility