Provider Demographics
NPI:1376284083
Name:3RD LEAF CLOVER CONSULTING LLC
Entity Type:Organization
Organization Name:3RD LEAF CLOVER CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:917-216-0844
Mailing Address - Street 1:2028 CRESTON AVE APT 8E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4272
Mailing Address - Country:US
Mailing Address - Phone:917-216-0844
Mailing Address - Fax:
Practice Address - Street 1:2028 CRESTON AVE APT 8E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4272
Practice Address - Country:US
Practice Address - Phone:917-216-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)