LAKEBRIDGE A WATERS COMMUNITY LLC
NPI 1043763592
Skilled Nursing Facility in Johnson City, TN

Active since August 02, 2016CLIA 44D0935514 · Waiver
115 WOODLAWN DR, JOHNSON CITY, TN 37604(423) 975-0095(423) 928-0358 Get Directions Write a Review

NPPES record last updated: August 2, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Lakebridge A Waters Community Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKEBRIDGE A WATERS COMMUNITY LLC (NPI 1043763592) is a healthcare organization registered as a skilled nursing facility in Johnson City, Tennessee and active in the NPI registry since August 2016. The organization holds a CLIA Waiver certificate valid through October 30, 2027 and lists Moishe Gubin, Member, as its authorized official.

NPPES Registry Identity

NPI1043763592
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameLAKEBRIDGE A WATERS COMMUNITY LLC
Location Address115 WOODLAWN DRJohnson City, TN 37604-5978
Mailing Address115 Woodlawn DrJohnson City, TN 37604-5978 · (423) 975-0095 · Fax (423) 928-0358
Fax(423) 928-0358
Organization SubpartNo
Authorized OfficialMoishe GubinMember · (708) 449-1900
Enumeration DateAugust 2, 2016
NPI 1043763592 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
115 WOODLAWN DR, Johnson City, TN 37604

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D0935514

Lakebridge A Water's Community, LLC · Johnson City, TN
Active · expires Oct 30, 2027
CLIA Number44D0935514
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateOctober 31, 2025
Certificate Expiration DateOctober 30, 2027
Laboratory DirectorAustin Stacy
Laboratory Phone(423) 975-0095
Laboratory LocationLakebridge A Water's Community, LLC115 Woodlawn Drive, Johnson City, TN 37604
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Skilled Nursing Facility
115 WOODLAWN DR
JOHNSON CITY, TN 37604
Skilled Nursing Facility
115 WOODLAWN DR
JOHNSON CITY, TN 37604
Physical Therapist
115 WOODLAWN DR
JOHNSON CITY, TN 37604
Nurse Practitioner (Family)
115 WOODLAWN DR
JOHNSON CITY, TN 37604
Skilled Nursing Facility
115 WOODLAWN DR
JOHNSON CITY, TN 37604

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lakebridge A Waters Community LLC's NPI number?

The NPI number for Lakebridge A Waters Community LLC is 1043763592. It was assigned to this organization in the NPPES registry on August 2, 2016.

Where is Lakebridge A Waters Community LLC located?

Lakebridge A Waters Community LLC is located at 115 Woodlawn Dr, Johnson City, TN 37604. The listed phone number is (423) 975-0095.

What is Lakebridge A Waters Community LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Lakebridge A Waters Community LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D0935514) is associated with this NPI, valid through October 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Lakebridge A Waters Community LLC accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of North Carolina and 3 other insurers list Lakebridge A Waters Community LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lakebridge A Waters Community LLC was last updated on August 2, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.