Provider Demographics
NPI:1003154345
Name:KLEAN ASTORIA - OR, LLC
Entity Type:Organization
Organization Name:KLEAN ASTORIA - OR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANSWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-435-8096
Mailing Address - Street 1:9000 W SUNSET BLVD
Mailing Address - Street 2:650 B
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5801
Mailing Address - Country:US
Mailing Address - Phone:310-740-4843
Mailing Address - Fax:310-657-4420
Practice Address - Street 1:1230 MARINE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4059
Practice Address - Country:US
Practice Address - Phone:503-325-2067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility