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General NPI Number Information
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NPI Number | 1891510251
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Entity Type | Organization
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Legal Business Name | CLEARWATER ASSISTED LIVING
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 800 WISCONSIN ST BLDG D04, STE 202
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City | EAU CLAIRE
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State | WI
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Zip | 54703
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Country | US
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Telephone | 715-514-9845
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Fax |
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Provider Business Mailing Address
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Address Line | 800 WISCONSIN ST MAIL BOX 80
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City | EAU CLAIRE
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State | WI
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Zip | 54703
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Country | US
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Telephone | 715-514-9845
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JORDAN KIMBALL MASON
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Credential |
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Telephone | 715-514-9845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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