Healthcare Provider Details

I. General information

NPI: 1548875990
Provider Name (Legal Business Name): CLARA'S LEGACY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2020
Last Update Date: 09/12/2020
Certification Date: 09/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 JAMESTOWN BLVD APT 1091
ALTAMONTE SPRINGS FL
32714-4681
US

IV. Provider business mailing address

659 JAMESTOWN BLVD APT 1091
ALTAMONTE SPRINGS FL
32714-4681
US

V. Phone/Fax

Practice location:
  • Phone: 407-960-5601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MS. TIFFANY BRINKLEY
Title or Position: DIRECTOR
Credential:
Phone: 407-960-5601