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NPI Code Detail

MEDICARE: AT HOME WITH CLV LLC

MEDICARE: AT HOME WITH CLV LLC
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1790486629
Entity Type Code : Organization
Provider Name (Legal Business Name) : AT HOME WITH CLV LLC
Provider Business Mailing Address
First Line : 101 W WINDSOR RD
Second Line :
City : URBANA
State : IL
Zip : 61802-6663
Country : US
Telephone Number : 217-356-1111
Fax Number :
Provider Business Practice Location Address
First Line : 101 W WINDSOR RD
Second Line :
City : URBANA
State : IL
Zip : 61802-6663
Country : US
Telephone Number : 217-356-1111
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : LAURA EDWARDS
Credential :
Telephone Number : 217-356-1111
Provider Enumeration Date : 03/16/2023
Last Update Date : 03/17/2023

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Directions to “AT HOME WITH CLV LLC ” Practice Location

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