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 |