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General NPI Number Information
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NPI Number | 1821960469
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Entity Type | Organization
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Legal Business Name | CLOVER CAREGIVERS LLC
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 3872 APOLLO DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-1689
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Country | US
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Telephone | 208-502-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 3872 APOLLO DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-1689
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Country | US
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Telephone | 208-502-0011
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Fax |
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Authorized Official
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Title or Position | OWNER/CARE MANAGER
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Name | PRESTON POULTER
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Credential | OTR/L
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Telephone | 208-502-0011
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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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