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General NPI Number Information
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NPI Number | 1275011355
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Entity Type | Organization
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Legal Business Name | CLOVER LLC
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 9765 RANDALL DR STE C
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City | CARMEL
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State | IN
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Zip | 46280-1817
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Country | US
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Telephone | 844-366-2587
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Fax | 317-536-3497
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Provider Business Mailing Address
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Address Line | 9765 RANDALL DR STE C
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City | CARMEL
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State | IN
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Zip | 46280-1817
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Country | US
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Telephone | 844-366-2587
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Fax | 317-536-3497
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Authorized Official
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Title or Position | OWNER
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Name | CARRIE TIDWELL
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Credential | RN
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Telephone | 844-366-2587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 18-013565
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License Number State | IN
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