Provider Demographics
NPI:1477247559
Name:C.L.C SUPPORTIVE IN- HOME CARE, LLC
Entity Type:Organization
Organization Name:C.L.C SUPPORTIVE IN- HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-470-9695
Mailing Address - Street 1:1136
Mailing Address - Street 2:SIR LANCELOT DR.
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-2631
Mailing Address - Country:US
Mailing Address - Phone:757-470-9695
Mailing Address - Fax:
Practice Address - Street 1:1136 SIR LANCELOT DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-2631
Practice Address - Country:US
Practice Address - Phone:757-470-9695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care