MEDICARE: CLARK CONTRACTING CO. 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	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1821653650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARK CONTRACTING CO. INC.

Provider Business Mailing Address
First Line	:	PO BOX 7756
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19803-0756
Country	:	US
Telephone Number	:	302-765-2228
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 GRAYROCK DR
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19803-3906
Country	:	US
Telephone Number	:	302-765-2228
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS H. CLARK JR.
Credential	:
Telephone Number	:	302-765-2228

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	05/07/2019

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