Provider Demographics
NPI:1790789675
Name:CLEARWATER REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:CLEARWATER REHABILITATION CENTER, LLC
Other - Org Name:CLEARWATER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-346-6454
Mailing Address - Street 1:1675 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-801-7600
Mailing Address - Fax:
Practice Address - Street 1:1270 TURNER ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5921
Practice Address - Country:US
Practice Address - Phone:727-443-7639
Practice Address - Fax:727-447-4852
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTHSTONE SENIOR COMMUNITIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-09
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1091096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021291100Medicaid
FL105274Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER