CLEANSE CLINIC JEFFERSONVILLE LLC; NPI #1942728472

Contact Information

CLEANSE CLINIC JEFFERSONVILLE LLC

1700 STATE ST
NEW ALBANY, IN 47150-4916

Phone: 812-914-7038
Fax: 812-748-6035
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Addiction Psychiatry	2084P0802X	86	Physician/Neuropsychiatry

Indicates primary specialty

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NPI Profile & details for CLEANSE CLINIC JEFFERSONVILLE LLC

NPI # 1942728472

LBN Legal business name CLEANSE CLINIC JEFFERSONVILLE LLC

Authorized official ABDUL BURIDI - (CEO)

Entity Organization

Organization subpart ¹ Yes

Enumeration date 09/05/2017

Last updated 01/31/2024 - About 2 years ago

Identifiers

IN	License #	1784-0-ASO
IN	Medicaid	300008912

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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