Clean Life Detox

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

CLEAN LIFE DETOX

Practice address

405 7TH Ave SW
Largo, FL 33770-3400

Phone

(727) 501-1040

NPI assigned

Sep 1, 2017

Reactivated

Sep 26, 2018

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mickoria Smith

Title

Chief Operating Officer

Phone

(561) 420-7501

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1215455928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 7TH AVE SW",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337703400",
            "telephone_number": "727-501-1040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 7TH AVE SW",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337703400",
            "telephone_number": "727-501-1040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAN LIFE DETOX",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-01",
        "last_updated": "2022-07-21",
        "deactivation_date": "2018-08-15",
        "reactivation_date": "2018-09-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MICKORIA",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "561-420-7501"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan Michael Clark, DO
• Christine Burns Clark, MD
• Dominique J Clark
• Claudette M Parham (Psychiatric Homecare)
• Jillian Clavenna, PA
• Clearwater Cardiovascular and Interventional Consultants MD PA (Clearwater Cardiovascular Consultants)
• Clearwater Surgical Associates, PLLC
• Jennifer Ann Clemans
• Martin Clemmons, D.O.
• Jasmin Click

• Substance Abuse Rehabilitation Facility in Largo, FL
• Providers in Largo, FL by specialty
• Substance Abuse Rehabilitation Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.