CLEANSE CLINIC JEFFERSONVILLE LLC NPI 1942728472

NPI Information

NPI: 1942728472
Provider Name: CLEANSE CLINIC JEFFERSONVILLE LLC
Classification: Psychiatry & Neurology - 2084P0802X
Entity Type: Organization

Specialization: Addiction Psychiatry

CLIA Number: 15D2138114

Address:
1700 STATE ST
NEW ALBANY, IN
ZIP 47150
Phone: (812) 914-7038
Get Directions

CLEANSE CLINIC JEFFERSONVILLE LLC is an addiction psychiatry psychiatry neurology in New Albany, IN. The provider is 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. CLEANSE CLINIC JEFFERSONVILLE LLC NPI is 1942728472. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1700 STATE ST
NEW ALBANY, IN
ZIP 47150-916
Phone: (812) 914-7038
Fax: (812) 748-6035

The provider's authorized official is Abdul G Buridi .
The authorized official title is Ceo and has the following contact phone number (502) 773-5088.

The CLIA number assigned to this NPI record is 15D2138114 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 9/5/2017 and was last updated on 1/31/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084P0802X	Psychiatry & Neurology	Addiction Psychiatry	1784-0-ASO	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	300008912	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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