Healthcare Provider Details

I. General information

NPI: 1346176229
Provider Name (Legal Business Name): CLARK HOME MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10809 SOUTHERN LOOP BLVD STE 2
PINEVILLE NC
28134-7426
US

IV. Provider business mailing address

2445 SELWYN AVE APT 503
CHARLOTTE NC
28209-1670
US

V. Phone/Fax

Practice location:
  • Phone: 704-245-6062
  • Fax:
Mailing address:
  • Phone: 704-363-4475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KEVIN EARL CLARK
Title or Position: PRESIDENT
Credential:
Phone: 704-245-6062