Provider Demographics
NPI:1225451453
Name:SIMPLY CLEAN AND GREEN LLC
Entity Type:Organization
Organization Name:SIMPLY CLEAN AND GREEN LLC
Other - Org Name:ETHAN ORR
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-275-5927
Mailing Address - Street 1:PO BOX 27669
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85726-7669
Mailing Address - Country:US
Mailing Address - Phone:520-571-8600
Mailing Address - Fax:
Practice Address - Street 1:1651 W GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-1433
Practice Address - Country:US
Practice Address - Phone:520-571-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health