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General NPI Number Information
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NPI Number | 1225334501
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Entity Type | Organization
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Legal Business Name | KLEAN START
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Dates
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Enumeration Date | 02/03/2011
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 12501 S WILMINGTON AVE
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City | COMPTON
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State | CA
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Zip | 90222-1220
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Country | US
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Telephone | 310-751-0821
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Fax |
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Provider Business Mailing Address
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Address Line | 3545 W LUTHER LN
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City | INGLEWOOD
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State | CA
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Zip | 90305-1886
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Country | US
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Telephone | 310-337-1292
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. RUDOLPH WASHINGTON
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Credential | MPA
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Telephone | 310-751-0821
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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 | 2518979
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License Number State | CA
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