Healthcare Provider Details

I. General information

NPI: 1912834342
Provider Name (Legal Business Name): VIRMONTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 POPLAR BEND BLVD
FISHERS IN
46037-8307
US

IV. Provider business mailing address

12220 POPLAR BEND BLVD
FISHERS IN
46037-8307
US

V. Phone/Fax

Practice location:
  • Phone: 312-450-5515
  • Fax:
Mailing address:
  • Phone: 312-450-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: KEVIN HILLSMAN
Title or Position: OWNER
Credential:
Phone: 312-450-5515