Provider Demographics
NPI:1790390839
Name:CLEAN & CLEAR ADVANTAGE, LLC
Entity Type:Organization
Organization Name:CLEAN & CLEAR ADVANTAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-488-7038
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:304-488-7038
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:304-488-7038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty