Provider Demographics
NPI:1821755471
Name:CLEARFORK CLEBURNE LLC
Entity Type:Organization
Organization Name:CLEARFORK CLEBURNE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-714-1311
Mailing Address - Street 1:7820 HANGER CUTOFF RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-9560
Mailing Address - Country:US
Mailing Address - Phone:817-259-2597
Mailing Address - Fax:817-977-9507
Practice Address - Street 1:1632 E FM 4
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031-8861
Practice Address - Country:US
Practice Address - Phone:817-259-2597
Practice Address - Fax:817-977-9507
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEARFORK ACADEMY LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility