MEDICARE: CLEARVIEW RECOVERY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	1234	IA

General Provider Information

NPI Number	:	1871641159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARVIEW RECOVERY, INC.

Provider Business Mailing Address
First Line	:	501 N SHERMAN ST
Second Line	:
City	:	PRAIRIE CITY
State	:	IA
Zip	:	50228-8666
Country	:	US
Telephone Number	:	515-994-3562
Fax Number	:	515-994-3564

Provider Business Practice Location Address
First Line	:	501 N SHERMAN ST
Second Line	:
City	:	PRAIRIE CITY
State	:	IA
Zip	:	50228-8666
Country	:	US
Telephone Number	:	515-994-3562
Fax Number	:	515-994-3564

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARV FANGMAN
Credential	:	M.A., LMSW, ACADC
Telephone Number	:	515-994-3562

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	08/22/2020

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