Clean Slate Living

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

10D2063192 Issued in FL

Legal business name

CLEAN SLATE LIVING

Practice address

118 Canoe Dr
West Palm Beach, FL 33415-2602

Phone

(561) 270-2361

NPI assigned

Oct 24, 2013

Organization subpart

No

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

Authorized official

Name

Angela Iacullo

Title

Billing Director

Phone

(561) 270-2361

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1382572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382572800000",
    "number": "1265860522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 CANOE DR",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334152602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 CANOE DR",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334152602",
            "telephone_number": "561-270-2361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAN SLATE LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-24",
        "last_updated": "2013-10-24",
        "status": "A",
        "authorized_official_last_name": "IACULLO",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "BILLING DIRECTOR",
        "authorized_official_telephone_number": "561-270-2361"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "10D2063192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven P Clawson, RPH
• Anissia Clayborn
• Cynthia Cadson Clayton, MD
• Dwanne Surelle Clayton, MSW, LCSW, CDP
• Clean & Sober Recovery Center, Inc. (Better Tomorrow Treatment Center)
• Clean Slate Recovery LLC
• Clean Slate Recovery LLC
• Clear Minds Health Services LLC
• Jessica Isacson Clements
• Alisha M Clemons

• Clinical Medical Laboratory in West Palm Beach, FL
• Providers in West Palm Beach, FL by specialty
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2013; 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.