Provider Demographics
NPI:1447948922
Name:CLEAR CARE LLC
Entity type:Organization
Organization Name:CLEAR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:612-859-5898
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE S137
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2891
Mailing Address - Country:US
Mailing Address - Phone:612-859-5898
Mailing Address - Fax:651-756-1821
Practice Address - Street 1:1821 UNIVERSITY AVE W STE S137
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2891
Practice Address - Country:US
Practice Address - Phone:612-859-5898
Practice Address - Fax:651-756-1821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA486630300Medicaid