Provider Demographics
NPI:1124687470
Name:THE CLOVER LION GROUP
Entity type:Organization
Organization Name:THE CLOVER LION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-500-9787
Mailing Address - Street 1:1606 SANTA ROSA RD RM 125
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5014
Mailing Address - Country:US
Mailing Address - Phone:804-500-9787
Mailing Address - Fax:
Practice Address - Street 1:1606 SANTA ROSA RD RM 125
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-5014
Practice Address - Country:US
Practice Address - Phone:804-500-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CLOVER LION GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care