Provider Demographics
NPI:1457553141
Name:CLEARWATER HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:CLEARWATER HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:GAYE
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:231866-636-5901
Mailing Address - Street 1:4765 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:KEWADIN
Mailing Address - State:MI
Mailing Address - Zip Code:49648-9162
Mailing Address - Country:US
Mailing Address - Phone:231-636-5901
Mailing Address - Fax:
Practice Address - Street 1:4765 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:KEWADIN
Practice Address - State:MI
Practice Address - Zip Code:49648-9162
Practice Address - Country:US
Practice Address - Phone:231-636-5901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093814Medicaid