Organization
VIRA DETOX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HODA BASHIR (CEO)
(612) 559-6937
Entity
Organization
Contact information
Practice address
3855 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-2518
(763) 200-6512
Mailing address
3855 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-2518
(763) 200-6512
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
10/10/2025
Last updated
11/05/2025
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