Healthcare Provider Details

I. General information

NPI: 1053012427
Provider Name (Legal Business Name): LASHAE CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 STEPHENSON PT
AKRON OH
44307-1465
US

IV. Provider business mailing address

708 STEPHENSON PT
AKRON OH
44307-1465
US

V. Phone/Fax

Practice location:
  • Phone: 234-334-9910
  • Fax:
Mailing address:
  • Phone: 234-334-9910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: