| Wabash Recovery | |
|
1236 N. Wabash Ave Kokomo IN 46901 | |
| (310) 741-7199 | |
| Not Available |
| Full Name | Wabash Recovery |
|---|---|
| Speciality | Clinic/Center |
| Location | 1236 N. Wabash Ave, Kokomo, Indiana |
| Authorized Official Name and Position | David Christenson (MANAGER) |
| Authorized Official Contact | 3174377040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wabash Recovery 302 S Reed Rd Kokomo IN 46901-4900 Ph: (765) 780-7689 | Wabash Recovery 1236 N. Wabash Ave Kokomo IN 46901 Ph: (310) 741-7199 |
| NPI Number | 1710587910 |
|---|---|
| Provider Enumeration Date | 10/27/2020 |
| Last Update Date | 11/05/2024 |
| Certification Date | 11/05/2024 |
| Medicare PECOS PAC ID | 4880062488 |
|---|---|
| Medicare Enrollment ID | O20221201000448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710587910 | NPI | - | NPPES |
| 300057826 | Medicaid | IN |
| Provider Name | Angela J Bowman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033280425 PECOS PAC ID: 8022174804 Enrollment ID: I20090303000279 |
| Provider Name | Theresa M Suozzi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952544199 PECOS PAC ID: 4981740016 Enrollment ID: I20140219000685 |
| Provider Name | Erin Rebecca Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962944454 PECOS PAC ID: 2769762186 Enrollment ID: I20161201000100 |
| Provider Name | Matthew Matteson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467096339 PECOS PAC ID: 7315370376 Enrollment ID: I20191204002620 |
| Provider Name | Anna Koblik Chen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972967982 PECOS PAC ID: 4789084195 Enrollment ID: I20240126002003 |
| Provider Name | Shani Berrios |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447026851 PECOS PAC ID: 2062859424 Enrollment ID: I20240320002805 |
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