Cindy L Clark

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

751442 Issued in WA

Practice address

616 S 30TH Ave
Yakima, WA 98902-4003

Phone

(509) 895-7149

Fax

(509) 895-7148

NPI assigned

Mar 19, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ellen House Afh LLC

  • Assisted Living Facility
  • Yakima, WA
  • NPI 1558193706
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552953600000",
    "number": "1992264766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 S 30TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989024003",
            "telephone_number": "509-895-7149",
            "fax_number": "509-895-7148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 S 30TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989024003",
            "telephone_number": "509-895-7149",
            "fax_number": "509-895-7148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CINDY",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-19",
        "last_updated": "2019-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "WA",
            "license": "751442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyla Clarabal, CM60797671
• Lauren Elizabeth Clark-Boucher, CPM, LM
• Caroline Clark, ARNP
• Christopher J Clark, DO
• Christopher J Clark, MED
• David Allen Clark, DDS
• Heather Clark
• Holly Clark, PHARMD
• Jeffrey Scott Clark, LMHC
• Jenatte Virginia Clark, ARNP

• Adult Care Home Facility in Yakima, WA
• Providers in Yakima, WA by specialty
• Adult Care Home Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.