Provider Demographics
NPI:1679347884
Name:CLOVER CARE TRANSPORT, INC
Entity Type:Organization
Organization Name:CLOVER CARE TRANSPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-424-4777
Mailing Address - Street 1:3057 CAMINO REAL LOOP
Mailing Address - Street 2:
Mailing Address - City:LILLIAN
Mailing Address - State:AL
Mailing Address - Zip Code:36549-3002
Mailing Address - Country:US
Mailing Address - Phone:251-407-5041
Mailing Address - Fax:
Practice Address - Street 1:3057 CAMINO REAL LOOP
Practice Address - Street 2:
Practice Address - City:LILLIAN
Practice Address - State:AL
Practice Address - Zip Code:36549-3002
Practice Address - Country:US
Practice Address - Phone:251-407-5041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)