Healthcare Provider Details

I. General information

NPI: 1265708689
Provider Name (Legal Business Name): KLEAN START, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 N CENTRAL AVE
COMPTON CA
90222-1640
US

IV. Provider business mailing address

3545 W LUTHER LN
INGLEWOOD CA
90305-1886
US

V. Phone/Fax

Practice location:
  • Phone: 310-751-0821
  • Fax:
Mailing address:
  • Phone: 310-337-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. RUDOLPH WASHINGTON
Title or Position: EXECUTIVE DIRECTOR
Credential: MPA
Phone: 310-751-0821