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General NPI Number Information
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NPI Number | 1649128216
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Entity Type | Organization
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Legal Business Name | CLEANSE WELLNESS COMPANY LLC
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Dates
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Enumeration Date | 03/19/2026
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 8620 NE BEECH ST
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City | PORTLAND
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State | OR
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Zip | 97220-5011
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Country | US
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Telephone | 503-969-0542
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Fax |
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Provider Business Mailing Address
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Address Line | 8620 NE BEECH ST
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City | PORTLAND
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State | OR
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Zip | 97220-5011
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Country | US
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Telephone | 503-969-0542
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | AUSTIN COLE KEEVER
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Credential | CADC-II
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Telephone | 503-969-0542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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