Healthcare Provider Details

I. General information

NPI: 1639836257
Provider Name (Legal Business Name): CLEAR SHORES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MAYO ST
HOLLYWOOD FL
33020-6542
US

IV. Provider business mailing address

1 OAKWOOD BLVD STE 265
HOLLYWOOD FL
33020-1954
US

V. Phone/Fax

Practice location:
  • Phone: 954-505-2200
  • Fax:
Mailing address:
  • Phone: 954-505-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RYAN NEEDLE
Title or Position: CEO
Credential:
Phone: 954-505-2200