# CLEAN COUNTRY LIVIN LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194311639
- **Authorized official:** SYLVIA BLACK (DIRECTOR OF BILLING AND INSURANCE)
- **Authorized official phone:** (830) 387-2065

## Contact information

- **Practice address:** 27158 TRITON DR, SPRING BRANCH, TX 78070-5043
- **Practice address phone:** (830) 387-2065
- **Mailing address:** 27158 TRITON DR, SPRING BRANCH, TX 78070-5043
- **Mailing address phone:** (830) 387-2065

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 177F00000X | Lodging Provider | — | NULL | Yes |

## Other

- **Enumeration date:** 12/18/2020
- **Last updated:** 12/18/2020