CLEARWATER SPRINGS AL GR, LLC
NPI 1114543501
Assisted Living Facility in Vancouver, WA

NPI Status: Active since June 22, 2020

Contact Information

201 NW 78TH ST
VANCOUVER, WA
ZIP 98665
Phone: (360) 546-3344

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  • Organization
  • Assisted Living Facility
  • CLIA Number: 50D2220765
  • CLIA Cert. Type: Assisted Living Facility
  • CLIA Exp. Date: 04-04-2028

About CLEARWATER SPRINGS AL GR, LLC

This page provides the complete NPI Profile along with additional information for Clearwater Springs Al Gr, Llc, a provider established in Vancouver, Washington operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1114543501 assigned on June 2020. The practitioner's primary taxonomy code is 310400000X. The provider is registered as an organization and their NPI record was last updated 5 years ago. The authorized official of this NPI record is Gregory Roderick (Member)

NPI
1114543501
Provider Name
CLEARWATER SPRINGS AL GR, LLC
Entity Type
Organization
Location Address
201 NW 78TH ST VANCOUVER, WA 98665
Location Phone
(360) 546-3344
Mailing Address
7420 SW BRIDGEPORT RD STE 105 PORTLAND, OR 97224
Mailing Phone
(503) 597-4906
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
06-22-2020
Last Update Date
06-22-2020
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Assisted Living Facility

Taxonomy Code
310400000X
Type
Nursing & Custodial Care Facilities
Taxonomy Description
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

GREGORY RODERICK

Authorized Official Title
MEMBER
Authorized Official Phone
(503) 443-1818

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
207240MEDICAID (05)WA 

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
50D2220765
Facility Type
Assisted Living Facility
Certificate Effective Date
April 14, 2021
Certificate Expiration Date
April 04, 2028
Laboratory Director
CHASITI INGRAM
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Clearwater Springs Al Gr, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

Reviews for CLEARWATER SPRINGS AL GR, LLC

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1114543501
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2124104650
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 1 + 2 + 4 + 1 + 0 + 4 + 6 + 5 + 0 + 24 = 49
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 49 = 11

The NPI number 1114543501 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 8 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1114032463 PATRICIA SUE VANWAGNER
Individual
Physical Therapist201 NW 78TH ST
VANCOUVER, WA 98665
(360) 694-9686
1891952511MS. BETH ANN FABEL OTR/L
Individual
Occupational Therapist201 NW 78TH ST
VANCOUVER, WA 98665
(360) 604-5678
1699065755 NATHAN MCATEE MPT
Individual
Physical Therapist (Geriatrics)201 NW 78TH ST
VANCOUVER, WA 98665
(360) 356-1952
1477836997CLEARWATER SPRINGS ASSISTED LIVING COMMUNITY
Organization
Assisted Living Facility201 NW 78TH ST
VANCOUVER, WA 98665
(360) 546-3344
1821393216PREMERE REHAB LLC
Organization
Physical Therapist201 NW 78TH ST
VANCOUVER, WA 98665
(888) 757-3422
1962280602 MEGAN ROSE FRAZIER COTA
Individual
Occupational Therapy Assistant201 NW 78TH ST
VANCOUVER, WA 98665
(435) 994-2792
1407620727 ARIEL EGGERS
Individual
Physical Therapy Assistant201 NW 78TH ST
VANCOUVER, WA 98665
(360) 262-1797
1982204509DR. UCHENDU EZRA IWUANYANWU OTD, OTR/L
Individual
Occupational Therapist201 NW 78TH ST
VANCOUVER, WA 98665
(360) 989-3825

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1114543501, enumerated in the NPI registry as an "organization" on June 22, 2020

The provider is located at 201 Nw 78th St Vancouver, Wa 98665 and the phone number is (360) 546-3344

This medical organization specializes in Assisted Living Facility with taxonomy code 310400000X

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

The provider's CLIA number is 50D2220765 for a "assisted living facility" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..

This NPI record was last updated on June 22, 2020. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.