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General NPI Number Information
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NPI Number | 1346137486
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Entity Type | Organization
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Legal Business Name | CLARK COMMUNITY CONNECTIONS LLC
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1200 STUYVESANT AVE APT A
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City | TRENTON
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State | NJ
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Zip | 08618-3484
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Country | US
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Telephone | 609-571-5730
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 STUYVESANT AVE APT A
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City | TRENTON
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State | NJ
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Zip | 08618-3484
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Country | US
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Telephone | 609-571-5730
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Fax |
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Authorized Official
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Title or Position | LICENSEE
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Name | TINA PAULETTE CLARK
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Credential |
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Telephone | 609-571-5730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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