Provider Demographics
NPI:1972973717
Name:CLEAR WATER CARE AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:CLEAR WATER CARE AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-692-0600
Mailing Address - Street 1:2055 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2118
Mailing Address - Country:US
Mailing Address - Phone:727-461-6613
Mailing Address - Fax:
Practice Address - Street 1:2055 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2118
Practice Address - Country:US
Practice Address - Phone:727-461-6613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015959500Medicaid
FL105453Medicare Oscar/Certification