Provider Demographics
NPI:1881932549
Name:CLARENCE-MARCELLUS PLACE
Entity type:Organization
Organization Name:CLARENCE-MARCELLUS PLACE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAKESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:214-462-0266
Mailing Address - Street 1:321 SIERRA WAY
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5121
Mailing Address - Country:US
Mailing Address - Phone:214-462-0266
Mailing Address - Fax:
Practice Address - Street 1:321 SIERRA WAY
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-5121
Practice Address - Country:US
Practice Address - Phone:214-462-0266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care