Provider Demographics
NPI:1861145393
Name:WORLDSHINE CLOVERLEAF LLC
Entity type:Organization
Organization Name:WORLDSHINE CLOVERLEAF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEHUANG
Authorized Official - Middle Name:
Authorized Official - Last Name:WENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-221-1165
Mailing Address - Street 1:20420 CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1174
Mailing Address - Country:US
Mailing Address - Phone:301-221-1165
Mailing Address - Fax:
Practice Address - Street 1:110 THOMAS JOHNSON DR STE 150
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4448
Practice Address - Country:US
Practice Address - Phone:301-221-1165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care