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Organization
ABRIA DETOX LLC
Active
Organization
ABRIA DETOX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IDMAN AHMEDNUR MOHAMED (CEO)
(952) 388-7640
Entity
Organization
Contact information
Practice address
14750 LAC LAVON DR, BURNSVILLE, MN 55306-6398
(612) 562-0561
Mailing address
PO BOX 654, LAKEVILLE, MN 55044-0654
(612) 562-0561
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
09/22/2022
Last updated
09/30/2023
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