Provider Demographics
NPI:1962291906
Name:CLARK JOHNSON ENTERPRISES LLC
Entity type:Organization
Organization Name:CLARK JOHNSON ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAKARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-227-6941
Mailing Address - Street 1:PO BOX 29044
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-0044
Mailing Address - Country:US
Mailing Address - Phone:216-200-8445
Mailing Address - Fax:
Practice Address - Street 1:7333 E LIVINGSTON AVE STE A
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3098
Practice Address - Country:US
Practice Address - Phone:216-200-8445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare