Healthcare Provider Details

I. General information

NPI: 1548945645
Provider Name (Legal Business Name): CLARENCE WEST JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 1ST ST
NORCO LA
70079-2207
US

IV. Provider business mailing address

903 1ST ST
NORCO LA
70079-2207
US

V. Phone/Fax

Practice location:
  • Phone: 504-357-1518
  • Fax:
Mailing address:
  • Phone: 504-357-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: