Provider Demographics
NPI:1043056872
Name:CLEAN AND CLEAR ADVANTAGE
Entity type:Organization
Organization Name:CLEAN AND CLEAR ADVANTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:740-444-2307
Mailing Address - Street 1:425 JULIANA ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5352
Mailing Address - Country:US
Mailing Address - Phone:304-893-9777
Mailing Address - Fax:
Practice Address - Street 1:425 JULIANA ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5352
Practice Address - Country:US
Practice Address - Phone:304-893-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care