Provider Demographics
NPI:1649867565
Name:CLARKE, FAIR VIVARD
Entity type:Individual
Prefix:
First Name:FAIR
Middle Name:VIVARD
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033-3541
Mailing Address - Country:US
Mailing Address - Phone:713-459-1753
Mailing Address - Fax:281-575-1845
Practice Address - Street 1:5010 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-3541
Practice Address - Country:US
Practice Address - Phone:713-459-1753
Practice Address - Fax:281-575-1845
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility