Provider Demographics
NPI:1205621604
Name:CLOVER CARE COORDINATION LLC
Entity type:Organization
Organization Name:CLOVER CARE COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MYEONGSUN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-280-9483
Mailing Address - Street 1:PO BOX 770198
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-0198
Mailing Address - Country:US
Mailing Address - Phone:907-280-9483
Mailing Address - Fax:907-313-7501
Practice Address - Street 1:13951 FIRE CREEK TRAIL DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7029
Practice Address - Country:US
Practice Address - Phone:907-280-9483
Practice Address - Fax:907-313-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management