Provider Demographics
NPI:1518685445
Name:CLB HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:CLB HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-905-4508
Mailing Address - Street 1:251 FORD ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-8419
Mailing Address - Country:US
Mailing Address - Phone:704-905-4508
Mailing Address - Fax:
Practice Address - Street 1:251 FORD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-8419
Practice Address - Country:US
Practice Address - Phone:704-905-4508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care