=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811156318
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE LOVING CLARKS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2008
-----------------------------------------------------
Last Update Date | 06/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2630 FOUNTAIN VIEW DR SUITE 226
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-7608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-974-6920
-----------------------------------------------------
Fax | 713-974-6922
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2630 FOUNTAIN VIEW DR SUITE 226
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-7608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-974-6920
-----------------------------------------------------
Fax | 713-974-6922
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. SELBY CLARK
-----------------------------------------------------
Credential | MBA, CSA
-----------------------------------------------------
Telephone | 713-974-6920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 010234
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------