Provider Demographics
NPI:1376197756
Name:CLEARWATER LIVING, LLC
Entity Type:Organization
Organization Name:CLEARWATER LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:NOVOTNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-789-4750
Mailing Address - Street 1:1213 HYLTON HEIGHTS RD STE 129
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2812
Mailing Address - Country:US
Mailing Address - Phone:785-789-4750
Mailing Address - Fax:
Practice Address - Street 1:620 E WOOD ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026-9757
Practice Address - Country:US
Practice Address - Phone:620-584-2271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility