Provider Demographics
NPI:1467709089
Name:CLEAR SPRINGS HEALTHCARE LLC
Entity Type:Organization
Organization Name:CLEAR SPRINGS HEALTHCARE LLC
Other - Org Name:THE RANCH AT CLEAR SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-209-6200
Mailing Address - Street 1:3662 PATTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:AQUILLA
Mailing Address - State:TX
Mailing Address - Zip Code:76622-2590
Mailing Address - Country:US
Mailing Address - Phone:469-209-6200
Mailing Address - Fax:254-829-1122
Practice Address - Street 1:3662 PATTON LAKE RD
Practice Address - Street 2:
Practice Address - City:AQUILLA
Practice Address - State:TX
Practice Address - Zip Code:76622-2590
Practice Address - Country:US
Practice Address - Phone:469-209-6200
Practice Address - Fax:254-829-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3551-3552276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit