Sparadise LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

SPARADISE LLC

Doing business as

Fancy Fun

Practice address

14602 NE Fourth Plain Blvd Ste a
Vancouver, WA 98682-5080

Phone

(608) 928-1913

NPI assigned

Dec 14, 2022

Last updated

Dec 14, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kristen Clearwater, LMTNPI 1881778710

Title

Owner

Phone

(360) 606-1694

Specialties & licenses 1

Addresses

Other names 2

• Fancy Fun Doing business as
• Clearwater Escape llc Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kristen K Clearwater, LMP

  • Specialist
  • Vancouver, WA
  • NPI 1881778710
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670976000000",
    "number": "1568174241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14602 NE FOURTH PLAIN BLVD STE A",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986825080",
            "telephone_number": "360-606-1694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14602 NE FOURTH PLAIN BLVD STE A",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986825080",
            "telephone_number": "608-928-1913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARADISE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-14",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A",
        "authorized_official_last_name": "CLEARWATER",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-606-1694",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fancy Fun",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clearwater Escape llc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Cole Southworth, DO
• Douglyn Souza, MA60508040
• Tanner William Souza
• Morgan Spady, MA70087679
• Jennifer Anne Spaeth, LMT
• Jacob Sparkowich
• Madison Sparks
• Wendy Jean Sparks, B.S.
• Edward A. Sparling, M.D.
• Marcia Sparling, MD

• Multi-Specialty Clinic/Center in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Multi-Specialty Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.