CLC, Inc

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

CLC, INC

Doing business as

Clean Living Centers

Practice address

1714 NE 72ND Cir
Vancouver, WA 98665-0586

Phone

(503) 515-5247

Fax

(360) 718-7949

NPI assigned

Mar 3, 2010

Last updated

Mar 3, 2010By 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

Lynn C Burgess, PH, D.

Title

Executive Director

Phone

(503) 515-5247

Specialties & licenses 1

Addresses

Other names 1

• Clean Living Centers Doing business as

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

{
    "created_epoch": "1267574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267574400000",
    "number": "1518280676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8002 NE HIGHWAY 99",
            "address_2": "PMB 617",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986658876",
            "telephone_number": "503-515-5247",
            "fax_number": "360-718-7949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 NE 72ND CIR",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986650586",
            "telephone_number": "503-515-5247",
            "fax_number": "360-718-7949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-03",
        "last_updated": "2010-03-03",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "503-515-5247",
        "authorized_official_credential": "PH, D."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clean Living Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Substance Abuse Rehabilitation Facility in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Substance Abuse Rehabilitation Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2010; 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.