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Organization
CLEANSE CLINIC JEFFERSONVILLE LLC
Active
Organization
CLEANSE CLINIC JEFFERSONVILLE LLC
Active
Parent organization
CLEANSE CLINIC CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLEANSE CLINIC CORPORATION
Authorized official
ABDUL G BURIDI MD (CEO)
(502) 773-5088
Entity
Organization
Contact information
Practice address
1700 STATE ST, NEW ALBANY, IN 47150-4916
(812) 914-7038
(812) 748-6035
Mailing address
720 W BROADWAY STE 202, LOUISVILLE, KY 40202-3245
(502) 561-0943
(502) 561-0944
Taxonomy
Speciality
Code
Description
License number
State
2084P0802X
Addiction Psychiatry Physician
Primary
1784-0-ASO
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300008912
—
IN
Enumeration date
09/05/2017
Last updated
01/31/2024
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