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General NPI Number Information
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NPI Number | 1508743584
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Entity Type | Organization
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Legal Business Name | CLOVERDALE INN INC
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 1114 W COUNTY LINE RD
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City | LUTZ
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State | FL
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Zip | 33558-5032
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Country | US
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Telephone | 813-949-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 1114 W COUNTY LINE RD
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City | LUTZ
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State | FL
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Zip | 33558-5032
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Country | US
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Telephone | 813-949-8999
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | STEPHANIE WELLS
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Credential | MEDICAL ASSISTANT
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Telephone | 813-598-7628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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