Provider Demographics
NPI:1568656304
Name:CLOVERLEAF HEALTHCARE SERVICES, LLC.
Entity Type:Organization
Organization Name:CLOVERLEAF HEALTHCARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:PAYPON
Authorized Official - Last Name:FLAVIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-704-7653
Mailing Address - Street 1:3423 SAINT CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6163
Mailing Address - Country:US
Mailing Address - Phone:832-704-7653
Mailing Address - Fax:
Practice Address - Street 1:236 ROLLING BROOK DR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-4165
Practice Address - Country:US
Practice Address - Phone:281-337-1706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health