| Indiana Center For Recovery Outpatient Services Llc | |
|
1578 E 85th Ave Merrillville IN 46410-8900 | |
| (561) 305-0461 | |
| Not Available |
| Full Name | Indiana Center For Recovery Outpatient Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1578 E 85th Ave, Merrillville, Indiana |
| Authorized Official Name and Position | Kirill Vesselov (PRESIDENT) |
| Authorized Official Contact | 5613050461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana Center For Recovery Outpatient Services Llc 2925 10th Ave N Palm Springs FL 33461-3000 Ph: (561) 305-0461 | Indiana Center For Recovery Outpatient Services Llc 1578 E 85th Ave Merrillville IN 46410-8900 Ph: (561) 305-0461 |
| NPI Number | 1093412793 |
|---|---|
| Provider Enumeration Date | 02/13/2023 |
| Last Update Date | 12/14/2023 |
| Certification Date | 12/14/2023 |
| Medicare PECOS PAC ID | 3173966363 |
|---|---|
| Medicare Enrollment ID | O20240205001766 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093412793 | NPI | - | NPPES |
| Provider Name | Dawn Marie Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467936070 PECOS PAC ID: 2163767344 Enrollment ID: I20181215000606 |
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