Healthcare Provider Details

I. General information

NPI: 1922956259
Provider Name (Legal Business Name): CLARK LEGACY HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N BRANDON BLVD
BRANDON MS
39042-8340
US

IV. Provider business mailing address

450 N BRANDON BLVD
BRANDON MS
39042-8340
US

V. Phone/Fax

Practice location:
  • Phone: 601-942-2115
  • Fax: 601-942-2115
Mailing address:
  • Phone: 601-942-2115
  • Fax: 601-942-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC FERLAINE CLARK SR.
Title or Position: OWNER
Credential:
Phone: 601-942-2115