Provider Demographics
NPI:1376389544
Name:CLC LLC
Entity type:Organization
Organization Name:CLC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:OGANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-849-5769
Mailing Address - Street 1:2465 SW LAURA AVE
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-1885
Mailing Address - Country:US
Mailing Address - Phone:503-849-5769
Mailing Address - Fax:866-793-8369
Practice Address - Street 1:2465 SW LAURA AVE
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-1885
Practice Address - Country:US
Practice Address - Phone:503-849-5769
Practice Address - Fax:866-793-8369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care