INDIANA CENTER FOR RECOVERY SOUTH BEND LLC NPI 1326790262

NPI Information

NPI: 1326790262
Provider Name: INDIANA CENTER FOR RECOVERY SOUTH BEND, LLC
Classification: Psychiatric Hospital - 283Q00000X
Entity Type: Organization

CLIA Number: 15D2272225

Address:
215 W 4TH ST
MISHAWAKA, IN
ZIP 46544
Phone: (561) 305-0461
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INDIANA CENTER FOR RECOVERY SOUTH BEND, LLC is a psychiatric hospital in Mishawaka, IN. The provider is an organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings. INDIANA CENTER FOR RECOVERY SOUTH BEND, LLC NPI is 1326790262. The provider is registered as an organization entity type.

The provider's business location address is:

215 W 4TH ST
MISHAWAKA, IN
ZIP 46544-917
Phone: (561) 305-0461

The provider's authorized official is Kirill Vesselov .
The authorized official title is Ceo and has the following contact phone number (561) 305-0461.

The CLIA number assigned to this NPI record is 15D2272225 - other - substance abuse with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/21/2022 and was last updated on 11/14/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261QM0850X	Clinic/Center	Adult Mental Health	No
2	320800000X	Community Based Residential Treatment Facility, Mental Illness		No
3	323P00000X	Psychiatric Residential Treatment Facility		No
4	324500000X	Substance Abuse Rehabilitation Facility		No
5	283Q00000X	Psychiatric Hospital		Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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