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General NPI Number Information
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NPI Number | 1801121140
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Entity Type | Organization
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Legal Business Name | KAREN CLARKE DBA TLC ADULT GROUP HOME
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Dates
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Enumeration Date | 10/05/2009
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 210 SOUNDWARD LN
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City | HERTFORD
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State | NC
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Zip | 27944-9749
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Country | US
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Telephone | 252-813-5557
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Fax |
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Provider Business Mailing Address
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Address Line | 210 SOUNDWARD LN
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City | HERTFORD
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State | NC
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Zip | 27944-9749
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Country | US
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Telephone | 252-813-5557
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KAREN DENISE CLARKE
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Credential |
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Telephone | 252-426-3496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MHL-072-008
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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