Provider Demographics
NPI:1437272085
Name:CLARKS RESIDENTIAL CARE HOME LLC
Entity type:Organization
Organization Name:CLARKS RESIDENTIAL CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-888-1700
Mailing Address - Street 1:213 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-9218
Mailing Address - Country:US
Mailing Address - Phone:802-888-1700
Mailing Address - Fax:802-888-9944
Practice Address - Street 1:213 CLARK RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05655-9218
Practice Address - Country:US
Practice Address - Phone:802-888-1700
Practice Address - Fax:802-888-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0370311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home