CLEAN LIFE DETOX – NPI #1215455928
Substance Abuse Rehabilitation Facility

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

CLEAN LIFE DETOX is a substance abuse rehabilitation facility located in LARGO, FL. NPPES has assigned the NPI number 1215455928 to CLEAN LIFE DETOX on September 01, 2017. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 324500000X from the Health Care Provider Taxonomy code set, which is classified as Substance Abuse Rehabilitation Facility.

The NPI profile was previously updated about 4 years ago on Jul 21, 2022. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for CLEAN LIFE DETOX below.

NPI Profile for
CLEAN LIFE DETOX

NPI Number
1215455928
Enumeration Date

(about 9 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
CLEAN LIFE DETOX
Primary location
405 7TH AVE SW
LARGO, FL 33770-3400
Phone: (727) 501-1040 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
MICKORIA SMITH
CHIEF OPERATING OFFICER
Phone: (561) 420-7501
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
324500000X
- Substance Abuse Rehabilitation Facility (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.