MEDICARE: THE LOVING CLARKS, INC.

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	010234	TX

General Provider Information

NPI Number	:	1295017481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LOVING CLARKS, INC.

Provider Business Mailing Address
First Line	:	6117 RICHMOND AVE
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77057-6256
Country	:	US
Telephone Number	:	713-974-6920
Fax Number	:	713-974-6922

Provider Business Practice Location Address
First Line	:	6117 RICHMOND AVE
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77057-6256
Country	:	US
Telephone Number	:	713-974-6920
Fax Number	:	713-974-6922

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SELBY CLARK
Credential	:	C.S.A.
Telephone Number	:	713-974-6920

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	08/08/2013

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