Provider Demographics
NPI:1164704748
Name:HOFFMAN CLARKE, AMIE
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:HOFFMAN CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60416-1628
Mailing Address - Country:US
Mailing Address - Phone:815-955-5471
Mailing Address - Fax:815-476-7361
Practice Address - Street 1:1197 S BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-1616
Practice Address - Country:US
Practice Address - Phone:815-476-5405
Practice Address - Fax:815-476-7361
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities