Provider Demographics
NPI:1851735724
Name:KONRAD MCCREE JR
Entity Type:Organization
Organization Name:KONRAD MCCREE JR
Other - Org Name:ASSISTED LIVING OF CLEARWATER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KONRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCREE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:727-271-7129
Mailing Address - Street 1:1968 CLEARVIEW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-1612
Mailing Address - Country:US
Mailing Address - Phone:727-271-7129
Mailing Address - Fax:
Practice Address - Street 1:8945 ENCHANTMENT DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-4802
Practice Address - Country:US
Practice Address - Phone:727-271-7129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home