Provider Demographics
NPI:1356117717
Name:CLEAR CREEK LIVING, LLC
Entity type:Organization
Organization Name:CLEAR CREEK LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEESTRATEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-625-0705
Mailing Address - Street 1:1836 W VIRGINIA ST STE 102A
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7714
Mailing Address - Country:US
Mailing Address - Phone:469-625-0705
Mailing Address - Fax:469-678-5060
Practice Address - Street 1:287 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412
Practice Address - Country:US
Practice Address - Phone:207-814-9500
Practice Address - Fax:207-825-2894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home