Provider Demographics
NPI:1417540998
Name:CLOVER COMMUNITY CARE LLC
Entity type:Organization
Organization Name:CLOVER COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARCIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-461-9955
Mailing Address - Street 1:222 S RANDOLPH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-3600
Mailing Address - Country:US
Mailing Address - Phone:910-461-9955
Mailing Address - Fax:
Practice Address - Street 1:627 E BROAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3758
Practice Address - Country:US
Practice Address - Phone:910-461-9955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty