Provider Demographics
NPI:1578051280
Name:CLARK, ERICA LA'SHAY
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LA'SHAY
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19219 SHAKERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6605
Mailing Address - Country:US
Mailing Address - Phone:216-703-6924
Mailing Address - Fax:
Practice Address - Street 1:100 E 216TH ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1155
Practice Address - Country:US
Practice Address - Phone:310-848-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health