Provider Demographics
NPI:1992862650
Name:CLEARWATER SUITES, INC.
Entity Type:Organization
Organization Name:CLEARWATER SUITES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-765-8841
Mailing Address - Street 1:16176 810TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRED HEART
Mailing Address - State:MN
Mailing Address - Zip Code:56285-1173
Mailing Address - Country:US
Mailing Address - Phone:320-765-8841
Mailing Address - Fax:
Practice Address - Street 1:1902 7TH AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2364
Practice Address - Country:US
Practice Address - Phone:320-759-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNHFID - 21247310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility