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General NPI Number Information
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NPI Number | 1811612674
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Entity Type | Organization
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Legal Business Name | CLEMONS GROUP HOME LLC
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 3111 CLEMONS RD
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City | PLANT CITY
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State | FL
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Zip | 33566-4643
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Country | US
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Telephone | 813-810-6844
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Fax | 813-602-2388
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Provider Business Mailing Address
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Address Line | 3111 CLEMONS RD
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City | PLANT CITY
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State | FL
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Zip | 33566-4643
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Country | US
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Telephone | 813-810-6844
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Fax | 813-602-2388
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CASSANDRA VIRGINIA SIMPSON
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Credential | BSN, RN
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Telephone | 813-810-6844
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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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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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