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General NPI Number Information
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NPI Number | 1538924352
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Entity Type | Organization
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Legal Business Name | ICARUS ADDICTION CARE
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Dates
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Enumeration Date | 02/20/2024
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 3443 DICKERSON PIKE STE 310
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City | NASHVILLE
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State | TN
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Zip | 37207-2523
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Country | US
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Telephone | 615-645-3013
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Fax | 615-621-3158
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Provider Business Mailing Address
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Address Line | 3443 DICKERSON PIKE STE 310
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City | NASHVILLE
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State | TN
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Zip | 37207-2523
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Country | US
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Telephone | 615-645-3013
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Fax | 615-621-3158
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JANINE ARCHULETA
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Credential |
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Telephone | 615-645-3013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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