MEDICARE: KLEAN TEAM 1031 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1023841798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLEAN TEAM 1031 LLC

Provider Business Mailing Address
First Line	:	1315 N. COOPER ST 126
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011
Country	:	US
Telephone Number	:	214-462-5387
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 N. COOPER ST 126
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011
Country	:	US
Telephone Number	:	214-462-5387
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. KENNETH WAYNE MOFFETT SR.
Credential	:	CERTIFIED NURSE AIDE
Telephone Number	:	214-462-5387

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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