Provider Demographics
NPI:1962000299
Name:CLEARWATER HOMES INC
Entity Type:Organization
Organization Name:CLEARWATER HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-319-9364
Mailing Address - Street 1:5254 LAKE RD E
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-9490
Mailing Address - Country:US
Mailing Address - Phone:440-319-9364
Mailing Address - Fax:
Practice Address - Street 1:5254 LAKE RD E
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-9490
Practice Address - Country:US
Practice Address - Phone:440-319-9364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities