Healthcare Provider Details

I. General information

NPI: 1952485872
Provider Name (Legal Business Name): CLEARVIEW-ROUTH LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W WASHINGTON ST
MOUNT AYR IA
50854-1324
US

IV. Provider business mailing address

406 W WASHINGTON ST
MOUNT AYR IA
50854-1324
US

V. Phone/Fax

Practice location:
  • Phone: 641-464-2240
  • Fax: 641-464-2230
Mailing address:
  • Phone: 641-464-2240
  • Fax: 641-464-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number800132
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0805945
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: GARY J ROUTH
Title or Position: OWNER
Credential:
Phone: 641-464-2240