Healthcare Provider Details

I. General information

NPI: 1841843372
Provider Name (Legal Business Name): CLAYTON INNOVATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 N TURKEY CREEK RD
LEICESTER NC
28748-5622
US

IV. Provider business mailing address

237 N TURKEY CREEK RD
LEICESTER NC
28748-5622
US

V. Phone/Fax

Practice location:
  • Phone: 828-273-4016
  • Fax:
Mailing address:
  • Phone: 828-273-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CAMERON CLAYTON SR.
Title or Position: OWNER/MEMBER
Credential:
Phone: 828-273-4016