MEDICARE: CLEARWATER HOMES 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1962000299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARWATER HOMES INC

Provider Business Mailing Address
First Line	:	5254 LAKE RD E
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9490
Country	:	US
Telephone Number	:	440-319-9364
Fax Number	:

Provider Business Practice Location Address
First Line	:	5254 LAKE RD E
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9490
Country	:	US
Telephone Number	:	440-319-9364
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHELLE PELLEY
Credential	:
Telephone Number	:	440-319-9364

Provider Enumeration Date	:	10/09/2020
Last Update Date	:	10/09/2020

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Directions to “CLEARWATER HOMES INC ” Practice Location

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