Abria Detox LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

ABRIA DETOX LLC

Practice address

14750 Lac Lavon Dr
Burnsville, MN 55306-6398

Phone

(612) 562-0561

NPI assigned

Sep 22, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Idman Ahmednur Mohamed

Title

Ceo

Phone

(952) 388-7640

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alfonso Morales-Utrilla Jr., M.D.

  • Family Medicine Physician
  • Saint Paul, MN
  • NPI 1407901499
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696032000000",
    "number": "1437872660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 654",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550440654",
            "telephone_number": "612-562-0561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14750 LAC LAVON DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553066398",
            "telephone_number": "612-562-0561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABRIA DETOX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-22",
        "last_updated": "2023-09-30",
        "certification_date": "2023-09-30",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "IDMAN",
        "authorized_official_middle_name": "AHMEDNUR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "952-388-7640"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abloom Health LLC
• Ably Home Health LLC
• Ingrid Abols-Mantyh, M.D.
• Haboon Aboubaker
• Matthew M. Abramson, DDS, MS
• Abria Recovery LLC
• Ilhan Hirsi Abshir
• Warda Abshir
• Mohamed Abud
• Omar Ezzaldin Abusteit

• Substance Use Disorder Rehabilitation Clinic/Center in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.