Provider Demographics
NPI:1629461355
Name:CLARK, HAROLD CHRISTOPHER II
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:CHRISTOPHER
Last Name:CLARK
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16021 NE 37TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7461
Mailing Address - Country:US
Mailing Address - Phone:360-713-7811
Mailing Address - Fax:
Practice Address - Street 1:6511 NE 18TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6869
Practice Address - Country:US
Practice Address - Phone:360-753-6082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home