Healthcare Provider Details

I. General information

NPI: 1114644028
Provider Name (Legal Business Name): CLOVER WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PARK CENTRAL BLVD S STE 1400
POMPANO BEACH FL
33064-2232
US

IV. Provider business mailing address

980 N FEDERAL HWY STE 110
BOCA RATON FL
33432-2704
US

V. Phone/Fax

Practice location:
  • Phone: 561-702-0987
  • Fax:
Mailing address:
  • Phone: 561-859-5958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN WALSH
Title or Position: CEO
Credential:
Phone: 561-702-9297