Provider Demographics
NPI:1063773844
Name:CLV ENTERPRISES, INC.
Entity type:Organization
Organization Name:CLV ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-894-5256
Mailing Address - Street 1:3108 EPPERLY DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-3414
Mailing Address - Country:US
Mailing Address - Phone:844-498-6471
Mailing Address - Fax:405-605-0422
Practice Address - Street 1:3108 EPPERLY DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3414
Practice Address - Country:US
Practice Address - Phone:844-498-6471
Practice Address - Fax:405-605-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS4683416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200472900AMedicaid