CLEANSE CLINIC, PSC (NPI# 1659726628) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659726628 |
| Entity Type | Organization |
| Organization Name | CLEANSE CLINIC, PSC |
| Practice Address |
9720 Park Plaza Ave Suite 104 Louisville KY 40241-2288 |
| Mailing Address |
720 W Broadway Ste 202 Louisville KY 40202-3245 |
| Practice Telephone | 5029380511 |
| Practice Fax Number | 5023716110 |
| Mailing Telephone | 5025610943 |
| Mailing Fax Number | 5025610944 |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2016-11-17 |
| Authorized Official Name | MARGARET GROLL (BUSINESS MANAGER) |
| Authorized Official Telephone | 5025610943 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0802X |
Psychiatry & Neurology Specialization: Addiction Psychiatry |
800212 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100413630 | 05 |
| Street Address |
9720 PARK PLAZA AVE SUITE 104 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40241-2288 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326033887 | Steven H Gray | Family Medicine | 9720 Park Plaza Ave, Suite 101, Louisville, KY 40241-2288 | 2005-09-12 |
| 1609259639 | Diana Tidal Hayes | Nurse Practitioner | 9720 Park Plaza Ave, Unit 104, Louisville, KY 40241-2288 | 2015-07-08 |
| 1184868317 | Virginia R Stokes, Md, Psc | Obstetrics & Gynecology | 9720 Park Plaza Ave, Suite 106, Louisville, KY 40241-2288 | 2009-05-01 |
| 1922246016 | Amy L Denley | Psychologist | 9720 Park Plaza Ave, Suite #102, Louisville, KY 40241-2288 | 2009-01-27 |
| 1922288687 | Sara Lynn Linstrom | Nurse Practitioner | 9720 Park Plaza Ave, Suite 104, Louisville, KY 40241-2288 | 2007-11-10 |
| 1144429101 | Diabetes & Endocrine Consultants Pllc | Internal Medicine | 9720 Park Plaza Ave, Suite 101, Louisville, KY 40241-2288 | 2007-07-11 |
| 1770631145 | Dana Joy Mcgaffee | Psychiatry & Neurology | 9720 Park Plaza Ave, Suite 104, Louisville, KY 40241-2288 | 2007-01-08 |
| 1053499046 | Associates In Infectious Diseases, Psc | Internal Medicine | 9720 Park Plaza Ave, Suite 104, Louisville, KY 40241-2288 | 2006-11-01 |
| 1669486346 | Kamran Akhtar | Internal Medicine | 9720 Park Plaza Ave, Suite 104, Louisville, KY 40241-2288 | 2006-07-28 |
| 1366498339 | Ramana Venkata Chennubhotla | Internal Medicine | 9720 Park Plaza Ave, Suite 101, Louisville, KY 40241-2288 | 2006-05-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164033353 | Tyler Roberts | Physician Assistant | Private, Louisville, KY 40241 | 2020-08-12 |
| 1639636988 | Paladina Health, LLC | Family Medicine | Paladina Health Louisville Park Plaza, 9720 Park Plaza Avenue #101, Louisville, KY 40241 | 2019-02-22 |
| 1164990396 | Tiffany Elizabeth Gallucci | Nurse Practitioner | 4915 Norton Healthcare Boulevard, Louisville, KS 40241 | 2018-11-06 |
| 1952876146 | Ashley Lynne Johnson Belcher | Psychologist | 9700 Park Plaza Avenue, Ste. 106, Louisville, KY 40241 | 2018-10-04 |
| 1265935977 | Family Podiatry Center Pllc | Podiatrist | 9850 Von Allmen Ct, Louisville, KY 40241 | 2018-03-09 |
| 1346767472 | Bridgett Lin Youngblood | Case Manager/Care Coordinator | 4313 Brownsboro Glen Rd, Louisville, KY 40241 | 2017-08-29 |
| 1518375690 | Amir Shahla | Dentist | 10500 Fischer Park Dr, Louisville, KY 40241 | 2014-08-01 |
| 1255741781 | Alicia M Durham | Marriage & Family Therapist | 3900 Riveroaks Ln, Louisville, KY 40241 | 2014-05-06 |
| 1962826719 | Applied Behavioral Consulting, LLC | Community/Behavioral Health | 4517 Shenandoah Drive, Louisville, KY 40241 | 2014-02-14 |
| 1336579176 | Nicholas Weickel | Physical Therapist | 9880 Angie's Way, Suite 100, Louisville, KY 40241 | 2013-11-14 |
| Find all providers in zip 40241 | ||||
| Taxonomy Code | 2084P0802X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Psychiatry |
| Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295211738 | Integrated Health Systems LLC | Psychiatry & Neurology | 645 S Roy Wilkins Ave Ste 300, Louisville, KY 40203 | 2018-07-18 |
| 1699092510 | John Maxwell Mccurdy | Psychiatry & Neurology | 2215 Portland Ave, Louisville, KY 40212-1033 | 2010-05-02 |
| 1053511949 | Erika Jaclyn Ruth | Psychiatry & Neurology | 401 E Chestnut St Unit 610, Louisville, KY 40202 | 2007-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356817274 | Kentucky Medical Services Foundation, Inc | Psychiatry & Neurology | 845 Angliana Ave, Lexington, KY 40508-3146 | 2018-10-18 |
| 1013113745 | Steven Lee Thore | Psychiatry & Neurology | 737b North Drive, Hopkinsville, KY 42240 | 2007-06-21 |
| City | LOUISVILLE |
| Zip Code | 40241 |
Please comment or provide details below to improve the information on CLEANSE CLINIC, PSC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.