MEDICARE: CHERYL CLARKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	321821	NY

General Provider Information

NPI Number	:	1013394667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHERYL CLARKE

Provider Business Mailing Address
First Line	:	1093 E 72ND ST
Second Line	:	3 RD FL
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5328
Country	:	US
Telephone Number	:	347-604-3232
Fax Number	:

Provider Business Practice Location Address
First Line	:	1093 E 72ND ST
Second Line	:	3 RD FL
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5328
Country	:	US
Telephone Number	:	347-604-3232
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHERYL CLARKE
Credential	:
Telephone Number	:	347-604-3232

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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