Provider Demographics
NPI:1336931872
Name:CLEARVISTA HOME CARE LLC
Entity type:Organization
Organization Name:CLEARVISTA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DE LONDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-954-6689
Mailing Address - Street 1:12814 BRISTOW LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7221
Mailing Address - Country:US
Mailing Address - Phone:317-954-6689
Mailing Address - Fax:
Practice Address - Street 1:12814 BRISTOW LN
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7221
Practice Address - Country:US
Practice Address - Phone:317-954-6689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care