CLEARWATER SPRINGS AL GR, LLC - NPI 1114543501 - Assisted Living Facility in Vancouver, WA

Q: What is Clearwater Springs Al Gr, LLC's NPI number?

The NPI number for Clearwater Springs Al Gr, LLC is 1114543501. It was assigned to this organization in the NPPES registry on June 22, 2020. The provider is doing business as Clearwater Springs Assisted Living.

Q: What is Clearwater Springs Al Gr, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

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About Clearwater Springs Al Gr, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLEARWATER SPRINGS AL GR, LLC (NPI 1114543501), doing business as Clearwater Springs Assisted Living, is a healthcare organization registered as an assisted living facility in Vancouver, Washington and active in the NPI registry since June 2020. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Gregory Roderick, Member, as its authorized official.

NPPES Registry Identity

NPI1114543501

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameCLEARWATER SPRINGS AL GR, LLC

Location Address201 NW 78TH STVancouver, WA 98665-7904

Mailing Address7420 Sw Bridgeport Rd Ste 105Portland, OR 97224-7790 · (503) 597-4906

Phone(360) 546-3344

Organization SubpartNo

Authorized OfficialGregory RoderickMember · (503) 443-1818

Enumeration DateJune 22, 2020

NPPES CertifiedJune 22, 2020

✔ NPI 1114543501 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

201 NW 78TH ST, Vancouver, WA 98665

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Other Names 1

Doing Business AsClearwater Springs Assisted Living

Other Identifiers 1

Medicaid207240WA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2220765

Clearwater Springs Assisted Living · Vancouver, WA

Active · expires Apr 4, 2028

CLIA Number50D2220765

Laboratory TypeAssisted Living Facility

Certificate Effective DateApril 14, 2021

Certificate Expiration DateApril 4, 2028

Laboratory DirectorChasiti Ingram

Laboratory Phone(360) 546-3344

Laboratory LocationClearwater Springs Assisted Living201 NW 78th St, Vancouver, WA 98665

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PATRICIA SUE VANWAGNER

Physical Therapist