Provider Demographics
NPI:1619702966
Name:TSA CLEAN LLC
Entity type:Organization
Organization Name:TSA CLEAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:QUENTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOERGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-410-9873
Mailing Address - Street 1:2085 LYNNHAVEN PKWY # 106-510
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1497
Mailing Address - Country:US
Mailing Address - Phone:262-879-4303
Mailing Address - Fax:
Practice Address - Street 1:2085 LYNNHAVEN PKWY # 106-510
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-1497
Practice Address - Country:US
Practice Address - Phone:262-879-4303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health