Clearwater Operations, LLC
Organization Active NPI Skilled Nursing Facility · Lewiston, ID
NPI 1235182155 · NPPES record last updated Jul 12, 2026
Key facts
- NPI
- 1235182155
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 85 (ID)
- Legal business name
- CLEARWATER OPERATIONS, LLC
- Practice address
- 325 Warner Dr
Lewiston, ID 83501-4437 - Phone
- (208) 798-8500
- Fax
- (208) 798-8530
- NPI assigned
- May 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Cindy S. Cross
- Title
- Assistant Secretary
- Phone
- (423) 473-5867
Owners & managing parties with NPI records 26
-
John Bradley Rudolph, D.O.
Facilities with the same owner 193
Affiliated clinicians 2
-
Donald J Greggain, M.D.
-
John Bradley Rudolph, D.O.
Medicare Care Compare: Nursing home
- Listed as
- Life Care Center of Lewiston
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★★ 5 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Oct 15, 1997
- Medicare certification status
- Active
- Certified beds
- 121 · 77.1 residents per day on average
- Chain
- Life Care Centers of America
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D0934334 | Life Care Center of Lewiston | Certificate of waiver | Oct 2, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Skilled nursing facility certification: CCN 135128
- Legal name
- CLEARWATER OPERATIONS LLC
- Doing business as
- LIFE CARE CENTER OF LEWISTON
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 15, 1997
- Last certification
- Aug 18, 2022
- Beds
- 121
- Ownership / control type
- Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 325 Warner Dr
Lewiston, ID 83501-4437 - Nursing home name
- LIFE CARE CENTER OF LEWISTON
- Affiliated entity
- LIFE CARE CENTERS OF AMERICA
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Forrest L Preston |
5% Or Greater Direct Ownership Interest |
Jul 14, 1994 | 99% |
| Adp of the SNF | Aug 31, 2000 | ||
| Direct Ownership Interest | Jul 14, 1994 | 99% | |
| Indirect Ownership Interest | Jul 14, 1994 | 1% | |
| Terry Henry |
Corporate Officer |
Aug 16, 1999 | |
| Heather Marie Jansen |
Operational/Managerial Control | Sep 16, 2024 | |
| Managing Control - Governing Body |
Sep 16, 2024 | ||
| John Bradley Rudolph |
Operational/Managerial Control | Jul 1, 2020 | |
| Adp of the SNF | Feb 28, 2025 | ||
| Todd Fletcher |
Operational/Managerial Control | Dec 13, 2024 | |
| Linda Baker |
Operational/Managerial Control | Sep 1, 2021 | |
| Managing Control - Governing Body |
Sep 1, 2021 | ||
| Adp of the SNF | Feb 28, 2025 | ||
| |
Adp of the SNF | Aug 31, 2000 | |
| Developers Investment Company Inc |
Operational/Managerial Control | Jan 1, 2017 | |
| Direct Ownership Interest | Jul 14, 1994 | 1% | |
| Aubrey Preston |
Operational/Managerial Control | Dec 13, 2024 | |
| Clearwater Operations LLC |
Operational/Managerial Control | Oct 15, 1997 | |
| Adp of the SNF | Aug 31, 2000 | ||
| Joan E Thurmond |
Corporate Officer |
Sep 21, 2000 | |
| Nancy Butner |
Operational/Managerial Control | Sep 16, 2018 | |
| Managing Control - Governing Body |
Sep 16, 2018 | ||
| Cindy S Cross |
Corporate Officer |
Apr 21, 1994 | |
| Richard Swanker |
Corporate Officer |
Apr 1, 2011 | |
| Life Care Centers of America, Inc. |
Operational/Managerial Control | Oct 15, 1997 | 100% |
| Adp of the SNF | Feb 28, 2025 | ||
| Lisa M Lay |
Corporate Officer |
Feb 9, 2018 | |
| James Ziegler |
Operational/Managerial Control | Dec 13, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040707001080 | ID | Part a Provider - Skilled Nursing Facility | 3870570864 | Practice locations: Lewiston, ID |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 85 | ID | Yes |
Addresses
Primary practice location
325 Warner Dr
Lewiston, ID 83501-4437
Mailing address
3001 Keith St NW
Cleveland, TN 37312-3713
Phone (423) 473-5751
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8050692 | Medicaid | ID | |
| 805069200 | Medicaid | ID |
Other names
- Life Care Center of Lewiston
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Lewiston, ID
- Clearwater Counseling
- Clearwater Gastroenterology
- Clearwater Medical Center PLLC
- Clearwater Neurosciences PLLC
- Clearwater Neurosurgery & Spinal Surgery Associates PLLC
- Clearwater Orthotics & Prosthetics
- Clearwater Orthotics and Prosthetics, LLC
- Clearwater Valley Optical
- Clearwater Vein Care Center PC
- Carrie Ann Coen
All providers in Lewiston, ID · Skilled Nursing Facility in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.