CLEANSE CLINIC JEFFERSONVILLE LLC (NPI# 1942728472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942728472 |
| Entity Type | Organization |
| Organization Name | CLEANSE CLINIC JEFFERSONVILLE LLC |
| Practice Address |
2818 Grant Line Rd Ste 2 New Albany IN 47150 |
| Mailing Address |
720 W Broadway Ste 202 Louisville KY 40202-3245 |
| Practice Telephone | 8129147038 |
| Practice Fax Number | 8129247661 |
| Mailing Telephone | 5025610943 |
| Mailing Fax Number | 5025610944 |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2018-07-18 |
| Authorized Official Name | ABDUL G BURIDI (CEO) |
| Authorized Official Telephone | 5027735088 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | CLEANSE CLINIC CORPORATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0802X |
Psychiatry & Neurology Specialization: Addiction Psychiatry |
1784-0-ASO | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 300008912 | 05 |
| Street Address |
2818 GRANT LINE RD STE 2 |
| City | NEW ALBANY |
| State | IN |
| Zip Code | 47150 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386287290 | Rosalind Scott Williams LLC | Nurse Practitioner | 2818 Grant Line Rd Ste 2, New Albany, IN 47150-2492 | 2019-10-23 |
| 1417412404 | Rosalind Williams | Nurse Practitioner | 2818 Grant Line Rd Ste 2, New Albany, IN 47150-2492 | 2019-02-05 |
| 1538635263 | Kathi Oneal | Physician Assistant | 2818 Grant Line Rd Ste 2, New Albany, IN 47150-2492 | 2018-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396385050 | Essential Pediatrics | Physical Therapist | 1614 Slate Run Road, New Albany, IN 47150 | 2020-01-10 |
| 1871075234 | Katie Lyn Vincent | Speech-Language Pathologist | 845 Park Place, New Albany, IN 47150 | 2018-09-02 |
| 1326528811 | Donna Casey Laduke | Respiratory Therapist, Registered | Baptist Health Floyd, 1850 State Street, New Albany, IN 47150 | 2018-08-15 |
| 1003307232 | Shelby Paige Buffin | Social Worker | 1612 Dewey St., Bld. 6 Apt. 2, New Albany, IN 47150 | 2018-05-23 |
| 1104315902 | Whitney Nicole Malloy | Physician Assistant | 2108 State Street, New Albany, IN 47150 | 2018-05-07 |
| 1881110765 | Kristy Marie Delaney | Social Worker | 1144 Creekview Circle, New Albany, IN 47150 | 2017-08-22 |
| 1891217030 | Sarah H. Wilson | Physician Assistant | 1919 State St Ste 362, New Albany, IN 47150 | 2017-07-10 |
| 1861939290 | Lauren Brenneman Pollock | Audiologist | 3211 Grant Line Rd St. #37, New Albany, IN 47150 | 2017-01-24 |
| 1861850414 | Kiley Madaleno | Speech-Language Pathologist | 4915 Charlestown Road, New Albany, IN 47150 | 2016-02-10 |
| 1386013167 | Angela Janet Horn | Psychologist | 2627 Charlestown Road, New Albany, IN 47150 | 2015-09-22 |
| Find all providers in zip 47150 | ||||
| Taxonomy Code | 2084P0802X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Psychiatry |
| Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710412754 | Richard S Murphy Do LLC | Psychiatry & Neurology | 12472 Breaklines St, Apt 402, Carmel, IN 46032-7659 | 2017-04-27 |
| 1639409659 | Brentwood Meadows Physician Group | Psychiatry & Neurology | 4488 Roslin Rd., Newburgh, IN 47630-8539 | 2010-01-14 |
| 1679707012 | Narendra Pratap Singh | Psychiatry & Neurology | 707 N Michigan St, Suite 400, South Bend, IN 46601-1067 | 2009-05-13 |
| 1790979748 | Community Hospitals of Indiana, Inc | Psychiatry & Neurology | 7229 Clearvista Dr, Indianapolis, IN 46256-1698 | 2007-09-04 |
| 1700833191 | Anjum S Ashraf | Psychiatry & Neurology | 3400 Lincoln Ave, Evansville, IN 47714-0147 | 2006-05-30 |
| 1053383083 | Dale E. Theobald | Psychiatry & Neurology | 7229 Clearvista Dr, Indianapolis, IN 46256-1698 | 2006-02-03 |
| City | NEW ALBANY |
| Zip Code | 47150 |
Please comment or provide details below to improve the information on CLEANSE CLINIC JEFFERSONVILLE LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.