Healthcare Provider Details

I. General information

NPI: 1922641992
Provider Name (Legal Business Name): THE CLARE PROPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E PEARSON ST
CHICAGO IL
60611-2535
US

IV. Provider business mailing address

400 LOCUST ST STE 820
DES MOINES IA
50309-2334
US

V. Phone/Fax

Practice location:
  • Phone: 312-951-5690
  • Fax: 312-784-8016
Mailing address:
  • Phone: 515-875-4500
  • Fax: 515-875-4780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DIANE BRIDGEWATER
Title or Position: EVP, TREASURER & SECRETARY
Credential:
Phone: 515-875-4768