Provider Demographics
NPI:1366220949
Name:CLAIRILUS, LENAIS
Entity type:Individual
Prefix:
First Name:LENAIS
Middle Name:
Last Name:CLAIRILUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 SEBRING PKWY
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-6605
Mailing Address - Country:US
Mailing Address - Phone:561-667-9706
Mailing Address - Fax:
Practice Address - Street 1:3905 SEBRING PKWY
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-6605
Practice Address - Country:US
Practice Address - Phone:561-667-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39973148251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health