MEDICARE: CLARK LEGACY HOME HEALTH, 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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1922956259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARK LEGACY HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	450 N BRANDON BLVD
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39042-8340
Country	:	US
Telephone Number	:	601-942-2115
Fax Number	:	601-942-2115

Provider Business Practice Location Address
First Line	:	450 N BRANDON BLVD
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39042-8340
Country	:	US
Telephone Number	:	601-942-2115
Fax Number	:	601-942-2115

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ERIC FERLAINE CLARK SR.
Credential	:
Telephone Number	:	601-942-2115

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	04/16/2026

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