Provider Demographics
NPI:1013394667
Name:CHERYL CLARKE
Entity Type:Organization
Organization Name:CHERYL CLARKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-604-3232
Mailing Address - Street 1:1093 E 72ND ST
Mailing Address - Street 2:3 RD FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5328
Mailing Address - Country:US
Mailing Address - Phone:347-604-3232
Mailing Address - Fax:
Practice Address - Street 1:1093 E 72ND ST
Practice Address - Street 2:3 RD FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5328
Practice Address - Country:US
Practice Address - Phone:347-604-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321821253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care