| NPI | 1568174241 |
|---|---|
| Former Legal Business Name | CLEARWATER ESCAPE LLC |
| Doing Business As | FANCY FUN |
| Entity Type | Organization |
| Authorized Contact | KRISTEN CLEARWATER Owner 360-606-1694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-12-14 |
| Last Update Date | 2022-12-14 |