Provider Demographics
NPI:1760781793
Name:CLOVER SENIOR CARE
Entity Type:Organization
Organization Name:CLOVER SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOODING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-443-7789
Mailing Address - Street 1:6721 RIDING WIND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4055
Mailing Address - Country:US
Mailing Address - Phone:361-443-7789
Mailing Address - Fax:361-288-8016
Practice Address - Street 1:6721 RIDING WIND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4055
Practice Address - Country:US
Practice Address - Phone:361-443-7789
Practice Address - Fax:361-288-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care