MEDICARE: LACRESHA D CLAY

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
2	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1023830866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACRESHA D CLAY

Provider Business Mailing Address
First Line	:	17 LEISURE SHORE CT
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-2003
Country	:	US
Telephone Number	:	832-368-8196
Fax Number	:

Provider Business Practice Location Address
First Line	:	8215 QUAIL HILLS DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-5402
Country	:	US
Telephone Number	:	832-368-8196
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2024
Last Update Date	:	10/31/2024

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Directions to “ LACRESHA D CLAY ” Practice Location

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