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General NPI Number Information
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NPI Number | 1851936124
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Entity Type | Organization
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Legal Business Name | CLEARWATER AL OPCO, LLC
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Dates
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Enumeration Date | 11/11/2019
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Last Update Date | 11/11/2019
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Provider Practice Location Address
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Address Line | 440 N 4TH ST
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City | CLEARWATER
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State | KS
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Zip | 67026-9708
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Country | US
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Telephone | 620-584-4257
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Fax | 620-584-4575
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Provider Business Mailing Address
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Address Line | 440 N 4TH ST
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City | CLEARWATER
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State | KS
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Zip | 67026-9708
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Country | US
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Telephone | 620-584-4257
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Fax | 620-584-4575
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Authorized Official
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Title or Position | CEO
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Name | MR. WILLIAM MATTHEW NOVOTNY
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Credential |
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Telephone | 785-789-4750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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