| Indiana Center For Recovery Outpatient Services Llc | |
|
7900 W Jefferson Blvd Fort Wayne IN 46804-4128 | |
| (561) 635-2400 | |
| Not Available |
| Full Name | Indiana Center For Recovery Outpatient Services Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 7900 W Jefferson Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Kirill Vesselov (PRESIDENT) |
| Authorized Official Contact | 5613050461 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana Center For Recovery Outpatient Services Llc 2925 10th Ave N Palm Springs FL 33461-3000 Ph: () - | Indiana Center For Recovery Outpatient Services Llc 7900 W Jefferson Blvd Fort Wayne IN 46804-4128 Ph: (561) 635-2400 |
| NPI Number | 1346949088 |
|---|---|
| Provider Enumeration Date | 03/02/2023 |
| Last Update Date | 12/14/2023 |
| Certification Date | 12/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346949088 | NPI | - | NPPES |
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