Provider Demographics
NPI:1962879528
Name:FRESH-N-CLEAN
Entity type:Organization
Organization Name:FRESH-N-CLEAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-517-5901
Mailing Address - Street 1:PO BOX 9755
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77213-0755
Mailing Address - Country:US
Mailing Address - Phone:832-717-2780
Mailing Address - Fax:800-918-6970
Practice Address - Street 1:4560 GRIGGS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2818
Practice Address - Country:US
Practice Address - Phone:832-517-5901
Practice Address - Fax:800-918-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-29
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No305S00000XManaged Care OrganizationsPoint of Service