NPI | 1376178129 |
---|---|
Doing Business As | CLEANSLATE CENTERS- GILBERT, AZ. |
Entity Type | Organization |
Authorized Contact | JESSICA AMICK AO 727-798-8160 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
Additional Taxonomies | 207R00000X Internal Medicine |
261QM0850X Clinic/Center, Adult Mental Health | |
Enumeration Date | 2020-03-11 |
Last Update Date | 2023-03-23 |