Provider Demographics
NPI:1477097244
Name:CLARK CARE AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:CLARK CARE AND REHABILITATION CENTER LLC
Other - Org Name:CLARK CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-635-1195
Mailing Address - Street 1:201 8TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:SD
Mailing Address - Zip Code:57225-1147
Mailing Address - Country:US
Mailing Address - Phone:605-532-3431
Mailing Address - Fax:605-532-3433
Practice Address - Street 1:201 8TH AVE NW
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:SD
Practice Address - Zip Code:57225-1147
Practice Address - Country:US
Practice Address - Phone:605-532-3431
Practice Address - Fax:605-532-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA435058OtherPTAN
435058Medicare Oscar/Certification