Provider Demographics
NPI:1407663115
Name:CLEAN SHOT LIVING
Entity type:Organization
Organization Name:CLEAN SHOT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-287-9715
Mailing Address - Street 1:1813 BETTY LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-6728
Mailing Address - Country:US
Mailing Address - Phone:877-457-6238
Mailing Address - Fax:
Practice Address - Street 1:1813 BETTY LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-6728
Practice Address - Country:US
Practice Address - Phone:877-457-6238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder