Provider Demographics
NPI:1063588226
Name:WATERMAN COMMUNITIES, INC.
Entity type:Organization
Organization Name:WATERMAN COMMUNITIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:DUJON
Authorized Official - Suffix:
Authorized Official - Credentials:
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:352-383-4693
Practice Address - Street 1:300 BROOKFIELD AVE
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-9562
Practice Address - Country:US
Practice Address - Phone:352-383-0051
Practice Address - Fax:352-383-0796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1138096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021068400Medicaid
FLK9TOtherBCBS PROVIDER #
FLK9TOtherBCBS PROVIDER #
FL0746250001Medicare NSC