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CLEANSE CLINIC, PLLC
NPI 1659726628
Psychiatry & Neurology - Addiction Psychiatry in Louisville, KY

Active since April 27, 2016CLIA 18D2120455 · Certificate of Compliance
645 S ROY WILKINS AVE STE 100, LOUISVILLE, KY 40203(502) 583-4092(502) 371-6110 Get Directions Write a Review

NPPES record last updated: August 13, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 13, 2024, Jul 29, 2023, Nov 17, 2016 and 1 more (4 updates tracked since 2016).

About Cleanse Clinic, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLEANSE CLINIC, PLLC (NPI 1659726628) is a healthcare organization registered as an addiction psychiatry in Louisville, Kentucky and active in the NPI registry since April 2016. The organization holds a CLIA Certificate of Compliance certificate valid through March 5, 2027, maintains 3 additional practice locations, and lists Margaret Groll, Business Manager, as its authorized official.

NPPES Registry Identity

NPI1659726628
Entity TypeOrganization
Primary Taxonomy2084P0802X
Legal Business NameCLEANSE CLINIC, PLLC
Location Address645 S ROY WILKINS AVE STE 100Louisville, KY 40203-2072
Mailing Address720 W Broadway Ste 202Louisville, KY 40202-3245 · (502) 561-0943 · Fax (502) 561-0944
Phone(502) 583-4092
Fax(502) 371-6110
Organization SubpartNo
Authorized OfficialMargaret GrollBusiness Manager · (812) 987-4330
Enumeration DateApril 27, 2016
Last NPPES UpdateAugust 13, 20244 updates tracked since enumeration
NPPES CertifiedAugust 13, 2024
✔ NPI 1659726628 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · Addiction PsychiatryAllopathic & Osteopathic Physicians
Taxonomy Code2084P0802X
License✔ Licensed in KY · 800212
Definition
Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders.
645 S ROY WILKINS AVE STE 100, Louisville, KY 40203
Open in Google Maps ↗

Secondary Practice Locations 3

Location 11700 State StNew Albany, IN 47150-4916 · Phone (812) 914-7038 · Fax (812) 748-6035
Location 21800 Highland AveCarrollton, KY 41008-8770 · Phone (502) 316-6675 · Fax (502) 371-6110
Location 31616 Harrodsburg RdLexington, KY 40504-3706 · Phone (859) 402-8224 · Fax (859) 523-0226

Other Identifiers 1

Medicaid7100413630KY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 18D2120455

Cleanse Clinic Psc · Louisville, KY
Active · expires Mar 5, 2027
CLIA Number18D2120455
Laboratory TypeIndependent
Certificate Effective DateMarch 6, 2025
Certificate Expiration DateMarch 5, 2027
Laboratory DirectorDr. Matthew Rycenga
Laboratory Phone(502) 561-0943
Laboratory LocationCleanse Clinic Psc645 S Roy Wilkins Ave, Louisville, KY 40203
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JANESSA MARIE JAMES APRN
Nurse Practitioner (Psychiatric/Mental Health)
645 S ROY WILKINS AVE STE 100
LOUISVILLE, KY 40203
Jefferson County (502) 583-4092
JORDAN MCEUEN TCADC
Counselor (Addiction (Substance Use Disorder))
645 S ROY WILKINS AVE STE 100
LOUISVILLE, KY 40203
Jefferson County (502) 583-4092
KIARNI LA TECE HALL-BLAKEMORE LCADC
Counselor (Addiction (Substance Use Disorder))
645 S ROY WILKINS AVE STE 100
LOUISVILLE, KY 40203
Jefferson County (502) 561-0943
DEVON FAHEY CSW
Social Worker (Clinical)
645 S ROY WILKINS AVE STE 100
LOUISVILLE, KY 40203
Jefferson County (502) 583-4092

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Cleanse Clinic, PLLC's NPI number?

The NPI number for Cleanse Clinic, PLLC is 1659726628. It was assigned to this organization in the NPPES registry on April 27, 2016.

Where is Cleanse Clinic, PLLC located?

Cleanse Clinic, PLLC is located at 645 S Roy Wilkins Ave Ste 100, Louisville, KY 40203. The listed phone number is (502) 583-4092.

What is Cleanse Clinic, PLLC's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Addiction Psychiatry, with taxonomy code 2084P0802X.

Does Cleanse Clinic, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 18D2120455) is associated with this NPI, valid through March 5, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Cleanse Clinic, PLLC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Home State Health and Ambetter of Tennessee list Cleanse Clinic, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Cleanse Clinic, PLLC was last updated on August 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.