Provider Demographics
NPI:1861030991
Name:ABRIA RECOVERY LLC
Entity Type:Organization
Organization Name:ABRIA RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-388-7640
Mailing Address - Street 1:13401 COUNTY ROAD 5
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2377
Mailing Address - Country:US
Mailing Address - Phone:952-388-7640
Mailing Address - Fax:
Practice Address - Street 1:13401 COUNTY ROAD 5
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2377
Practice Address - Country:US
Practice Address - Phone:952-406-8105
Practice Address - Fax:952-446-7273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty