Healthcare Provider Details

I. General information

NPI: 1376197756
Provider Name (Legal Business Name): CLEARWATER LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E WOOD ST
CLEARWATER KS
67026-9757
US

IV. Provider business mailing address

1213 HYLTON HEIGHTS RD STE 129
MANHATTAN KS
66502-2812
US

V. Phone/Fax

Practice location:
  • Phone: 620-584-2271
  • Fax:
Mailing address:
  • Phone: 785-789-4750
  • Fax:

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: MR. WILLIAM MATTHEW NOVOTNY
Title or Position: CEO
Credential:
Phone: 785-789-4750