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General NPI Number Information
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NPI Number | 1801315346
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Entity Type | Organization
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Legal Business Name | CLARK HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 09/15/2017
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Provider Practice Location Address
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Address Line | 7803 CRYSTAL MOON DR
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City | HOUSTON
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State | TX
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Zip | 77040-6058
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Country | US
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Telephone | 713-856-5265
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Fax |
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Provider Business Mailing Address
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Address Line | 7803 CRYSTAL MOON DR
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City | HOUSTON
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State | TX
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Zip | 77040-6058
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Country | US
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Telephone | 713-856-5265
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JACQUELINE JOHNSON
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Credential |
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Telephone | 713-856-5265
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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 | 018225
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License Number State | TX
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