Cleanse Clinic, Psc

LBN: Cleanse Clinic, Psc
Cleanse Clinic, Psc is an health care organization with primary practice located at 645 S Roy Wilkins Ave Ste 100 , Louisville KY 40203-2072. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Addiction Psychiatry, which is considered as the primary health care specialty. Cleanse Clinic, Psc can be contacted via phone (502) 583-4092, or through Groll, Margaret via phone (812) 987-4330.

Contact Information

Primary practice address
645 S Roy Wilkins Ave Ste 100 Louisville KY 40203-2072
Phone: (502) 583-4092
Fax: (502) 371-6110
Website:
Map and Directions
Authorized official contact:
Name: Groll, Margaret
Phone: (812) 987-4330

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Addiction Psychiatry 2084P0802X 800212 Kentucky

Profile Details

NPI number 1659726628
LBN Legal business name Cleanse Clinic, Psc
DBA Doing business as
Authorized official Groll, Margaret
Entity Organization
Organization subpart 1 No
Enumeration date Apr 27th, 2016
Last updated Jan 31st, 2024 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659726628 NPPES
Kentucky MEDICAID 7100413630

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