Clearwater Al Opco, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

CLEARWATER AL OPCO, LLC

Practice address

440 N 4TH St
Clearwater, KS 67026-9708

Phone

(620) 584-4257

Fax

(620) 584-4575

NPI assigned

Nov 11, 2019

Organization subpart

No

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

Authorized official

Name

Mr. William Matthew Novotny

Title

Ceo

Phone

(785) 789-4750

Specialties & licenses 1

Addresses

Other names 1

• Clearwater Village/Harbor Home Doing business as

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

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573430400000",
    "number": "1851936124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 N 4TH ST",
            "city": "CLEARWATER",
            "state": "KS",
            "postal_code": "670269708",
            "telephone_number": "620-584-4257",
            "fax_number": "620-584-4575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 N 4TH ST",
            "city": "CLEARWATER",
            "state": "KS",
            "postal_code": "670269708",
            "telephone_number": "620-584-4257",
            "fax_number": "620-584-4575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARWATER AL OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-11",
        "last_updated": "2019-11-11",
        "status": "A",
        "authorized_official_last_name": "NOVOTNY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "785-789-4750",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clearwater Village/Harbor Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bales Pharmacy, Inc.
• Roger A. Bales, PHARMACIST
• Wendy Jean Booker, PT
• Sarah Brown, PHARM D.
• City of Clearwater
• Clearwater Family Practice PA
• Clearwater Living, LLC
• Clearwater Retirement Community Inc.
• Cindy Davidson, SLP
• Charisse C Frisch, DDS

• All providers in Clearwater, KS
• Assisted Living Facility in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2019; 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.