1134235757 NPI number — CLEAR BROOK, INC.

Table of content: (NPI 1134235757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134235757 NPI number — CLEAR BROOK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEAR BROOK, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLEAR BROOK MANOR/CLEAR BROOK LODGE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134235757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 N RIVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18702-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-822-0800
Provider Business Mailing Address Fax Number:
570-822-0817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 E NORTHAMPTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL RUN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18706-9520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-823-1171
Provider Business Practice Location Address Fax Number:
570-823-1582
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCGOVERN
Authorized Official First Name:
BRENDAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
570-822-0800

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  401889/402119 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com