MEDICARE: NANCY CLARK & ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1619056645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANCY CLARK & ASSOCIATES

Provider Business Mailing Address
First Line	:	471 OLD NEWPORT BLVD
Second Line	:	SUITE 101
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	471 OLD NEWPORT BLVD
Second Line	:	SUITE 101
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4235
Country	:	US
Telephone Number	:	949-631-0550
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. NANCY K CLARK
Credential	:
Telephone Number	:	949-631-0550

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/22/2020

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