Basic Information
| Provider Information | |||||||||
| NPI: | 1750608568 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLARKE COMMUNITY SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13016 EASTFIELD RD STE 200-205 | ||||||||
| Address2: | |||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280786622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049687557 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3308 TULANE AVE STE 407 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701197158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048216830 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2010 | ||||||||
| LastUpdateDate: | 02/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | BIDGOOD | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7049687557 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.