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General NPI Number Information
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NPI Number | 1659965903
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Entity Type | Organization
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Legal Business Name | ELAINE E. CLARK CARE LLC
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Dates
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Enumeration Date | 02/26/2021
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 6027 ELLSWORTH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19143-2330
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Country | US
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Telephone | 267-334-9151
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Fax |
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Provider Business Mailing Address
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Address Line | 6027 ELLSWORTH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19143-2330
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JHAZZMIN PORTER
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Credential |
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Telephone | 267-423-6022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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