Organization
CLEANSE CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARGARET GROLL (BUSINESS MANAGER)
(812) 987-4330
Entity
Organization
Contact information
Practice address
645 S ROY WILKINS AVE STE 100, LOUISVILLE, KY 40203-2072
(502) 583-4092
(502) 371-6110
Mailing address
720 W BROADWAY STE 202, LOUISVILLE, KY 40202-3245
(502) 561-0943
(502) 561-0944
Taxonomy
Speciality
Code
Description
License number
State
2084P0802X
Addiction Psychiatry Physician
Primary
800212
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100413630
—
KY
Enumeration date
04/27/2016
Last updated
08/13/2024
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