Provider Demographics
NPI:1063523157
Name:SARMA BEHAVIORAL HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:SARMA BEHAVIORAL HEALTH CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-899-8008
Mailing Address - Street 1:24646 NOVA LN
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2743
Mailing Address - Country:US
Mailing Address - Phone:217-899-8008
Mailing Address - Fax:
Practice Address - Street 1:24646 NOVA LN
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33980-2743
Practice Address - Country:US
Practice Address - Phone:217-899-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209970Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER