Healthcare Provider Details

I. General information

NPI: 1285038935
Provider Name (Legal Business Name): CLEARWATER IN-HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 BUSINESS HIGHWAY 60 SUITE C
DEXTER MO
63841
US

IV. Provider business mailing address

PO BOX 859
DEXTER MO
63841-0859
US

V. Phone/Fax

Practice location:
  • Phone: 573-614-5886
  • Fax: 573-614-5894
Mailing address:
  • Phone: 573-614-5886
  • Fax: 573-614-5894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. BILLIE JO DELORES CRANE
Title or Position: SECRETARY/MANAGER
Credential:
Phone: 573-614-5886