=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992600084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLOVER LHCSA MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2026
-----------------------------------------------------
Last Update Date | 10/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 838 FAIR ST
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10512-3085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-878-4111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 460 BAYVIEW AVE
-----------------------------------------------------
City | INWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11096-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | CHARLES EDOUARD GROS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-360-8083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------