MEDICARE: MRS. ROSA LEE BROWN-CLARK

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	372500000X	Chore Provider
2	372600000X	Adult Companion
3	376J00000X	Homemaker

General Provider Information

NPI Number	:	1083079602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSA LEE BROWN-CLARK

Provider Business Mailing Address
First Line	:	453 CODY DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4214
Country	:	US
Telephone Number	:	904-699-2601
Fax Number	:

Provider Business Practice Location Address
First Line	:	453 CODY DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4214
Country	:	US
Telephone Number	:	904-699-2601
Fax Number	:

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

Provider Enumeration Date	:	12/26/2015
Last Update Date	:	12/26/2015

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