Healthcare Provider Details

I. General information

NPI: 1487939161
Provider Name (Legal Business Name): CLARKE COMMUNITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6529 HUDSPETH RD
HARRISBURG NC
28075-5004
US

IV. Provider business mailing address

6529 HUDSPETH RD
HARRISBURG NC
28075-5004
US

V. Phone/Fax

Practice location:
  • Phone: 704-455-3500
  • Fax: 704-455-3503
Mailing address:
  • Phone: 704-455-3500
  • Fax: 704-455-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC4459
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC4459
License Number StateNC

VIII. Authorized Official

Name: DANIEL BIDGOOD
Title or Position: PARTNER/DIRECTOR
Credential:
Phone: 704-455-3500