| Indiana Center For Recovery Adolescent Program Llc | |
|
215 W 4th St Mishawaka IN 46544-1917 | |
| (561) 305-0461 | |
| Not Available |
| Full Name | Indiana Center For Recovery Adolescent Program Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 215 W 4th St, Mishawaka, Indiana |
| Authorized Official Name and Position | Kirill Vesselov (PRESIDENT) |
| Authorized Official Contact | 5616352400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana Center For Recovery Adolescent Program Llc 2925 10th Ave N Palm Springs FL 33461-3000 Ph: () - | Indiana Center For Recovery Adolescent Program Llc 215 W 4th St Mishawaka IN 46544-1917 Ph: (561) 305-0461 |
| NPI Number | 1457196735 |
|---|---|
| Provider Enumeration Date | 06/27/2024 |
| Last Update Date | 07/05/2024 |
| Certification Date | 07/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457196735 | NPI | - | NPPES |
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