Organization
CLOVER HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARRELL A CREEL (CLOVER HOUSE HOME MANAGER)
(706) 295-2388
Entity
Organization
Contact information
Practice address
496 N AVERY RD NW, ROME, GA 30165-7970
(706) 295-2388
(706) 413-1719
Mailing address
496 N AVERY RD NW, ROME, GA 30165-7970
(706) 295-2388
(706) 413-1719
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
057-01-039-1
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
247792228A
—
GA
Enumeration date
01/16/2010
Last updated
01/16/2010
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