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General NPI Number Information
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NPI Number | 1093514994
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Entity Type | Organization
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Legal Business Name | WE CLEAN UP WELL LLC
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 5106 MALIBU CT
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City | LOUISVILLE
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State | KY
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Zip | 40216-1660
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Country | US
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Telephone | 804-475-2349
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Fax |
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Provider Business Mailing Address
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Address Line | 1526 S 30TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40211-1802
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Country | US
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Telephone | 804-475-2349
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING ADMIN
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Name | JACQUELINE SANDERS
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Credential |
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Telephone | 502-365-3394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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