Provider Demographics
NPI:1760160907
Name:CLARK HOME AND HEALTH SERVICES PLC
Entity Type:Organization
Organization Name:CLARK HOME AND HEALTH SERVICES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:TENNYSON CLARK
Authorized Official - Last Name:WISMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT
Authorized Official - Phone:517-242-0425
Mailing Address - Street 1:1302 SANDHILL DR
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9550
Mailing Address - Country:US
Mailing Address - Phone:517-242-4042
Mailing Address - Fax:517-237-6089
Practice Address - Street 1:1302 SANDHILL DR
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9550
Practice Address - Country:US
Practice Address - Phone:517-242-4042
Practice Address - Fax:517-237-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty