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General NPI Number Information
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NPI Number | 1013821594
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Entity Type | Organization
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Legal Business Name | 4 KLOVERS KITCHEN LLC
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 5505 HALL CIR
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City | UNION CITY
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State | GA
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Zip | 30291-1007
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Country | US
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Telephone | 323-559-5482
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Fax |
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Provider Business Mailing Address
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Address Line | 5505 HALL CIR
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City | UNION CITY
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State | GA
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Zip | 30291-1007
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Country | US
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Telephone | 323-559-5482
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE MINTERS
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Credential |
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Telephone | 323-559-5482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State | NULL
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