Healthcare Provider Details

I. General information

NPI: 1407819246
Provider Name (Legal Business Name): CLEARWATER RETIREMENT COMMUNITY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/11/2025
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

620 E WOOD ST
CLEARWATER KS
67026-9757
US

V. Phone/Fax

Practice location:
  • Phone: 620-584-2271
  • Fax: 620-584-4583
Mailing address:
  • Phone: 620-584-2271
  • Fax: 620-584-4583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNO87016
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberNO87053
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberBO87124
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberBO87123
License Number StateKS

VIII. Authorized Official

Name: MRS. IZENA MONK
Title or Position: ADMINISTRATOR
Credential:
Phone: 620-584-2271