Provider Demographics
NPI:1639705833
Name:CLEAR SPACE SUPERVISION & CONSULTING LLC
Entity Type:Organization
Organization Name:CLEAR SPACE SUPERVISION & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANE-ORENTLIKHER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:330-289-2859
Mailing Address - Street 1:1303 AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2101
Mailing Address - Country:US
Mailing Address - Phone:330-289-2859
Mailing Address - Fax:
Practice Address - Street 1:1303 AUTUMN LN
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2101
Practice Address - Country:US
Practice Address - Phone:330-289-2859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0214419Medicaid