Provider Demographics
NPI:1528438066
Name:PLAY CLAUSE LLC
Entity type:Organization
Organization Name:PLAY CLAUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY BASED REHABILITATIVE SER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLAUSEL
Authorized Official - Suffix:
Authorized Official - Credentials:BS, ITFS
Authorized Official - Phone:336-870-1937
Mailing Address - Street 1:110 BRIGHTLEAF CT
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-3193
Mailing Address - Country:US
Mailing Address - Phone:336-870-1937
Mailing Address - Fax:
Practice Address - Street 1:110 BRIGHTLEAF CT
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-3193
Practice Address - Country:US
Practice Address - Phone:336-870-1937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-27
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty