MEDICARE: NAFRESHA ABUAUN PRIVATE PRACTICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1568270676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAFRESHA ABUAUN PRIVATE PRACTICE LLC

Provider Business Mailing Address
First Line	:	17 STANTON DR
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-8632
Country	:	US
Telephone Number	:	937-835-4901
Fax Number	:	937-848-1535

Provider Business Practice Location Address
First Line	:	2555 S DIXIE DR STE 201
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-1532
Country	:	US
Telephone Number	:	937-835-4901
Fax Number	:	937-848-1535

Authorized Official
Title or Position	:	OWNER
Name	:	NAFRESHA ABUAUN
Credential	:
Telephone Number	:	937-835-4901

Provider Enumeration Date	:	12/20/2024
Last Update Date	:	12/20/2024

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