Provider Demographics
NPI:1679743132
Name:TWO IN CLOVER, INC.
Entity type:Organization
Organization Name:TWO IN CLOVER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-701-0696
Mailing Address - Street 1:224 VIRGINIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-856-9186
Mailing Address - Fax:
Practice Address - Street 1:5973 ENCINA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-2273
Practice Address - Country:US
Practice Address - Phone:805-856-9186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6138730001Medicare NSC