Provider Demographics
NPI:1134235757
Name:CLEAR BROOK, INC.
Entity type:Organization
Organization Name:CLEAR BROOK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-822-0800
Mailing Address - Street 1:37 N RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2403
Mailing Address - Country:US
Mailing Address - Phone:570-822-0800
Mailing Address - Fax:570-822-0817
Practice Address - Street 1:1100 E NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:LAUREL RUN
Practice Address - State:PA
Practice Address - Zip Code:18706-9520
Practice Address - Country:US
Practice Address - Phone:570-823-1171
Practice Address - Fax:570-823-1582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA401889/402119324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility