Provider Demographics
NPI:1487939161
Name:CLARKE COMMUNITY CARE LLC
Entity type:Organization
Organization Name:CLARKE COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-455-3500
Mailing Address - Street 1:6529 HUDSPETH RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-5004
Mailing Address - Country:US
Mailing Address - Phone:704-455-3500
Mailing Address - Fax:704-455-3503
Practice Address - Street 1:6529 HUDSPETH RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-5004
Practice Address - Country:US
Practice Address - Phone:704-455-3500
Practice Address - Fax:704-455-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4459253Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6602350Medicaid
NC3419194Medicaid