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Contact Information

CLEANSE CLINIC, PLLC
645 S ROY WILKINS AVE STE 100
LOUISVILLE, KY40203-2072
 Phone: 502-583-4092
 Fax: 502-371-6110
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Addiction Psychiatry

2084P0802X 86 Physician/Neuropsychiatry
Indicates primary specialty

NPI Profile & details for CLEANSE CLINIC, PLLC

NPI Number 1659726628
LBN Legal business name CLEANSE CLINIC, PLLC
Authorized official MARGARET GROLL - (BUSINESS MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/27/2016
Last updated 08/13/2024 - More than a year ago
Identifiers
KY License # 800212
KY Medicaid 7100413630
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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