Provider Demographics
NPI:1407306954
Name:CLOVER MEADOWS ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:CLOVER MEADOWS ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TEXUS
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-656-2443
Mailing Address - Street 1:13920 EYLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4664
Mailing Address - Country:US
Mailing Address - Phone:407-656-2443
Mailing Address - Fax:
Practice Address - Street 1:6609 LA JOLLA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6849
Practice Address - Country:US
Practice Address - Phone:407-656-2443
Practice Address - Fax:877-287-9424
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALMARK HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-08
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12772385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child