Provider Demographics
NPI:1740432152
Name:CLARK ENTERPRISES 407 LLC
Entity Type:Organization
Organization Name:CLARK ENTERPRISES 407 LLC
Other - Org Name:COMFORT KEEPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-429-6666
Mailing Address - Street 1:1398 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3737
Mailing Address - Country:US
Mailing Address - Phone:217-429-6666
Mailing Address - Fax:217-429-3620
Practice Address - Street 1:1398 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3737
Practice Address - Country:US
Practice Address - Phone:217-429-6666
Practice Address - Fax:217-429-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care