Provider Demographics
NPI:1285038935
Name:CLEARWATER IN-HOME CARE, INC.
Entity Type:Organization
Organization Name:CLEARWATER IN-HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BILLIE JO
Authorized Official - Middle Name:DELORES
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-614-5886
Mailing Address - Street 1:PO BOX 859
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-0859
Mailing Address - Country:US
Mailing Address - Phone:573-614-5886
Mailing Address - Fax:573-614-5894
Practice Address - Street 1:1525 BUSINESS HIGHWAY 60
Practice Address - Street 2:SUITE C
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841
Practice Address - Country:US
Practice Address - Phone:573-614-5886
Practice Address - Fax:573-614-5894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care