Individual
DEMETRIA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
709 LODGE AVE, TOLEDO, OH 43609-2915
(567) 702-1078
Mailing address
709 LODGE AVE, TOLEDO, OH 43609-1173
(567) 702-1078
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
—
—
251E00000X
Home Health Agency
Primary
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
343800000X
Secured Medical Transport (VAN)
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
08/05/2019
Last updated
10/02/2022
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