Healthcare Provider Details

I. General information

NPI: 1306825005
Provider Name (Legal Business Name): CLOVER FAMILY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S CHURCH ST
BURLINGTON NC
27215-5046
US

IV. Provider business mailing address

1040 S CHURCH ST
BURLINGTON NC
27215-5046
US

V. Phone/Fax

Practice location:
  • Phone: 336-222-8052
  • Fax: 336-222-8091
Mailing address:
  • Phone: 336-222-8052
  • Fax: 336-222-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00131
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JASON ALEXANDER
Title or Position: PRESIDENT
Credential:
Phone: 919-812-4557