Clean Slate Recovery LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

5084241799701 Issued in FL

Legal business name

CLEAN SLATE RECOVERY LLC

Practice address

2695 N Military TRL
Suite 26
West Palm Beach, FL 33409-2974

Phone

(561) 660-6549

NPI assigned

Jun 29, 2016

Last updated

Jun 29, 2016By 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

Suzanne Madison

Title

Chief Executive Officer

Phone

(561) 660-6549

Specialties & licenses 1

Addresses

Tax ID family

Clean Slate Recovery LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Clean Slate Recovery LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • West Palm Beach, FL
  • NPI 1861948499
  NPD tax ID

Locations

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

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467158400000",
    "number": "1942651187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 N MILITARY TRL",
            "address_2": "SUITE 26",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334092974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2695 N MILITARY TRL",
            "address_2": "SUITE 26",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334092974",
            "telephone_number": "561-660-6549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAN SLATE RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-29",
        "last_updated": "2016-06-29",
        "status": "A",
        "authorized_official_last_name": "MADISON",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "561-660-6549"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "FL",
            "license": "5084241799701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Cadson Clayton, MD
• Dwanne Surelle Clayton, MSW, LCSW, CDP
• Clean & Sober Recovery Center, Inc. (Better Tomorrow Treatment Center)
• Clean Slate Living
• Clean Slate Recovery LLC
• Clear Minds Health Services LLC
• Jessica Isacson Clements
• Alisha M Clemons
• Cleopatra Ortiz, MD, PA
• Carline Clerge, D.C.

• Substance Use Disorder Rehabilitation Clinic/Center in West Palm Beach, FL
• Providers in West Palm 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 Jun 29, 2016; 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.