Provider Demographics
NPI:1700401882
Name:CLEAR WATER HOSPICE INC
Entity Type:Organization
Organization Name:CLEAR WATER HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-262-5396
Mailing Address - Street 1:6931 VAN NUYS BLVD STE 315A
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3998
Mailing Address - Country:US
Mailing Address - Phone:747-262-5396
Mailing Address - Fax:818-465-3389
Practice Address - Street 1:6931 VAN NUYS BLVD STE 315A
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3998
Practice Address - Country:US
Practice Address - Phone:747-262-5396
Practice Address - Fax:818-465-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based