Provider Demographics
NPI:1104349588
Name:CLEAR WATERS HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:CLEAR WATERS HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:FOLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LATINWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-343-4881
Mailing Address - Street 1:40 GROVE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4873
Mailing Address - Country:US
Mailing Address - Phone:845-313-9268
Mailing Address - Fax:845-355-2193
Practice Address - Street 1:40 GROVE ST STE 105
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4873
Practice Address - Country:US
Practice Address - Phone:845-313-9268
Practice Address - Fax:845-355-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1980L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health