Organization
CLEAN SLATE SOBER LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FANNIE WOODS (CREDENTIALING SPECIALIST)
(844) 548-7627
Entity
Organization
Contact information
Practice address
714 E MAIN ST, TROTWOOD, OH 45426-2909
(844) 548-7627
Mailing address
714 E MAIN ST, TROTWOOD, OH 45426-2909
(184) 454-8762
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
10/14/2020
Last updated
10/14/2020
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