Healthcare Provider Details

I. General information

NPI: 1538924352
Provider Name (Legal Business Name): ICARUS ADDICTION CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 DICKERSON PIKE STE 310
NASHVILLE TN
37207-2523
US

IV. Provider business mailing address

3443 DICKERSON PIKE STE 310
NASHVILLE TN
37207-2523
US

V. Phone/Fax

Practice location:
  • Phone: 615-645-3013
  • Fax: 615-621-3158
Mailing address:
  • Phone: 615-645-3013
  • Fax: 615-621-3158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANINE ARCHULETA
Title or Position: ADMINISTRATOR
Credential:
Phone: 615-645-3013