Healthcare Provider Details

I. General information

NPI: 1740975200
Provider Name (Legal Business Name): IATREIA MENTAL HEALTH SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/06/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 RICHARDS ST
JOLIET IL
60433-2745
US

IV. Provider business mailing address

PO BOX 9412
NAPERVILLE IL
60567-0412
US

V. Phone/Fax

Practice location:
  • Phone: 312-554-5431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BIKRAM SHARMA
Title or Position: PRESIDENT
Credential: MD
Phone: 312-554-5431