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General NPI Number Information
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NPI Number | 1235182155
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Entity Type | Organization
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Legal Business Name | CLEARWATER OPERATIONS, LLC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 325 WARNER DR
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City | LEWISTON
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State | ID
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Zip | 83501-4437
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Country | US
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Telephone | 208-798-8500
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Fax | 208-798-8530
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Provider Business Mailing Address
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Address Line | 3001 KEITH ST NW
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City | CLEVELAND
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State | TN
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Zip | 37312-3713
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Country | US
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Telephone | 423-473-5751
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Fax | 423-339-8342
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | CINDY S. CROSS
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Credential |
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Telephone | 423-473-5867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 85
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License Number State | ID
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