Provider Demographics
NPI:1699945212
Name:CLEAN VISION RECOVERY LLC
Entity type:Organization
Organization Name:CLEAN VISION RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:O
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-254-7613
Mailing Address - Street 1:564 LONG SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8460
Mailing Address - Country:US
Mailing Address - Phone:828-654-7545
Mailing Address - Fax:828-654-7544
Practice Address - Street 1:564 LONG SHOALS RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8460
Practice Address - Country:US
Practice Address - Phone:828-654-7545
Practice Address - Fax:828-654-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-011-291324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility