Provider Demographics
NPI:1497175426
Name:THE CLAIR WINSTON HOUSE,LLC
Entity Type:Organization
Organization Name:THE CLAIR WINSTON HOUSE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-402-1079
Mailing Address - Street 1:132 W STANSELL AVE
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2056
Mailing Address - Country:US
Mailing Address - Phone:904-402-1079
Mailing Address - Fax:
Practice Address - Street 1:132 W STANSELL AVE
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2056
Practice Address - Country:US
Practice Address - Phone:904-402-1079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12481311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home