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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