Healthcare Provider Details

I. General information

NPI: 1841671682
Provider Name (Legal Business Name): CLEAR SHORES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OAKWOOD BLVD STE 265
HOLLYWOOD FL
33020-1956
US

IV. Provider business mailing address

1 OAKWOOD BLVD STE 265
HOLLYWOOD FL
33020-1956
US

V. Phone/Fax

Practice location:
  • Phone: 954-505-2200
  • Fax: 877-990-2532
Mailing address:
  • Phone: 954-505-2200
  • Fax: 877-990-2532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. RYAN NEEDLE
Title or Position: CFO
Credential:
Phone: 716-946-9075