Provider Demographics
NPI:1174027163
Name:NICE AND CLEAN MEDICAL SERVICES
Entity type:Organization
Organization Name:NICE AND CLEAN MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-754-8889
Mailing Address - Street 1:450 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-3424
Mailing Address - Country:US
Mailing Address - Phone:850-363-9306
Mailing Address - Fax:855-326-8575
Practice Address - Street 1:795 NW JAKE GLN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-5322
Practice Address - Country:US
Practice Address - Phone:850-363-9306
Practice Address - Fax:855-326-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)