Healthcare Provider Details

I. General information

NPI: 1861145393
Provider Name (Legal Business Name): WORLDSHINE CLOVERLEAF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 THOMAS JOHNSON DR STE 150
FREDERICK MD
21702-4448
US

IV. Provider business mailing address

20420 CENTURY BLVD
GERMANTOWN MD
20874-1174
US

V. Phone/Fax

Practice location:
  • Phone: 301-221-1165
  • Fax:
Mailing address:
  • Phone: 301-221-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEHUANG WENG
Title or Position: CFO
Credential:
Phone: 301-221-1165