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General NPI Number Information
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NPI Number | 1346176229
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Entity Type | Organization
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Legal Business Name | CLARK HOME MOBILITY LLC
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Dates
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Enumeration Date | 06/19/2026
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Last Update Date | 06/19/2026
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Provider Practice Location Address
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Address Line | 10809 SOUTHERN LOOP BLVD STE 2
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City | PINEVILLE
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State | NC
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Zip | 28134-7426
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Country | US
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Telephone | 704-245-6062
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Fax |
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Provider Business Mailing Address
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Address Line | 2445 SELWYN AVE APT 503
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City | CHARLOTTE
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State | NC
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Zip | 28209-1670
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Country | US
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Telephone | 704-363-4475
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN EARL CLARK
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Credential |
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Telephone | 704-245-6062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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