Provider Demographics
NPI:1053153361
Name:CLEARCHECK HOLDINGS LLC
Entity type:Organization
Organization Name:CLEARCHECK HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNIE
Authorized Official - Suffix:
Authorized Official - Credentials:CADC,SAP,CEAP
Authorized Official - Phone:208-404-3636
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:BLISS
Mailing Address - State:ID
Mailing Address - Zip Code:83314-0159
Mailing Address - Country:US
Mailing Address - Phone:208-404-3636
Mailing Address - Fax:
Practice Address - Street 1:479 POLK SUIT B
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-404-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility