Organization
KLEAN LIFE DETOX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KASALI OPABOLA JR. (CEO)
(561) 634-6400
Entity
Organization
Contact information
Practice address
207 E BLUE HERON BLVD STE 3, RIVIERA BEACH, FL 33404-4560
(561) 634-6400
Mailing address
7135 VIA ABRUZZI, LAKE WORTH, FL 33467-6940
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
10/03/2018
Last updated
10/03/2018
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