Provider Demographics
NPI:1962057570
Name:CLONWHITE LLC
Entity type:Organization
Organization Name:CLONWHITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-638-0638
Mailing Address - Street 1:FIRSTLIGHT HOME CARE
Mailing Address - Street 2:344 EAST MAIN ST, SUITE LL004
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-215-1915
Mailing Address - Fax:
Practice Address - Street 1:117 FORREST AVE STE 207
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2366
Practice Address - Country:US
Practice Address - Phone:610-638-0638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care