Provider Demographics
NPI:1255778312
Name:CLARKES QUALITY CARE, LLC
Entity type:Organization
Organization Name:CLARKES QUALITY CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILLICENT
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MILLER-CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-215-5156
Mailing Address - Street 1:729 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-3901
Mailing Address - Country:US
Mailing Address - Phone:941-474-5456
Mailing Address - Fax:
Practice Address - Street 1:2214 VALRICO FOREST DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3709
Practice Address - Country:US
Practice Address - Phone:813-215-5156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7293310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility