Healthcare Provider Details

I. General information

NPI: 1942607775
Provider Name (Legal Business Name): SHREYA HEALTH OF UTAH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W 100 S
DELTA UT
84624-9238
US

IV. Provider business mailing address

PO BOX 5915
SAN CLEMENTE CA
92674-5915
US

V. Phone/Fax

Practice location:
  • Phone: 302-454-1265
  • Fax:
Mailing address:
  • Phone: 949-276-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. TONMOY SHARMA
Title or Position: CEO
Credential:
Phone: 302-454-1265