Provider Demographics
NPI:1114613882
Name:CLARA BRAVE HEART COMPANION SERVICES LLC
Entity Type:Organization
Organization Name:CLARA BRAVE HEART COMPANION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-520-8191
Mailing Address - Street 1:PO BOX 26784
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-6784
Mailing Address - Country:US
Mailing Address - Phone:904-520-8191
Mailing Address - Fax:
Practice Address - Street 1:3341 DIGNAN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-3910
Practice Address - Country:US
Practice Address - Phone:904-520-8191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care