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General NPI Number Information
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NPI Number | 1861030991
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Entity Type | Organization
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Legal Business Name | ABRIA RECOVERY LLC
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Dates
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Enumeration Date | 12/19/2019
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Last Update Date | 12/12/2020
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Provider Practice Location Address
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Address Line | 13401 COUNTY ROAD 5
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City | BURNSVILLE
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State | MN
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Zip | 55337-2377
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Country | US
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Telephone | 952-406-8105
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Fax | 952-446-7273
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Provider Business Mailing Address
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Address Line | 13401 COUNTY ROAD 5
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City | BURNSVILLE
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State | MN
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Zip | 55337-2377
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Country | US
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Telephone | 952-388-7640
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. IDMAN A MOHAMED
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Credential |
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Telephone | 952-388-7640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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