Provider Demographics
NPI:1326394784
Name:CLEAR CHOICE ELDER HEALTH CARE SOLUTIONS LLC
Entity Type:Organization
Organization Name:CLEAR CHOICE ELDER HEALTH CARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-839-5904
Mailing Address - Street 1:17861 OAKMONT RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-7202
Mailing Address - Country:US
Mailing Address - Phone:239-839-5904
Mailing Address - Fax:239-362-3298
Practice Address - Street 1:17861 OAKMONT RIDGE CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-7202
Practice Address - Country:US
Practice Address - Phone:239-839-5904
Practice Address - Fax:239-362-3298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 107071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty