Klean Life Detox

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

KLEAN LIFE DETOX

Practice address

207 E Blue Heron Blvd Ste 3
Riviera Beach, FL 33404-4560

Phone

(561) 634-6400

NPI assigned

Oct 3, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Kasali Opabola Jr.

Title

Ceo

Phone

(561) 634-6400

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1538524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538524800000",
    "number": "1861967002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7135 VIA ABRUZZI",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334676940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E BLUE HERON BLVD STE 3",
            "city": "RIVIERA BEACH",
            "state": "FL",
            "postal_code": "334044560",
            "telephone_number": "561-634-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KLEAN LIFE DETOX",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-03",
        "last_updated": "2018-10-03",
        "status": "A",
        "authorized_official_last_name": "OPABOLA",
        "authorized_official_first_name": "KASALI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-634-6400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kindred Hospital Palm Beach LLC
• Courtney King
• Natalia Za'Kiya King
• Whitney L Kirk, MSW
• Aimee L Kirvin, BA
• KM Platinum Health LLC
• KND Development 59 LLC
• Marisa C Knight
• John William Knispel, MD
• Bernard Koliskor, MD

• Substance Use Disorder Rehabilitation Clinic/Center in Riviera Beach, FL
• Providers in Riviera Beach, FL by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; 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.