| Wellpoint Recovery Llc | |
|
3930 Mezzanine Dr Ste B Lafayette IN 47905-8646 | |
| (765) 771-7108 | |
| (765) 269-9569 |
| Full Name | Wellpoint Recovery Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3930 Mezzanine Dr Ste B, Lafayette, Indiana |
| Authorized Official Name and Position | Amabel Piris (PRACTICE MANAGER) |
| Authorized Official Contact | 7657717108 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellpoint Recovery Llc 3930 Mezzanine Dr Ste B Lafayette IN 47905-8646 Ph: (765) 771-7108 | Wellpoint Recovery Llc 3930 Mezzanine Dr Ste B Lafayette IN 47905-8646 Ph: (765) 771-7108 |
| NPI Number | 1518447309 |
|---|---|
| Provider Enumeration Date | 08/21/2018 |
| Last Update Date | 03/11/2019 |
| Medicare PECOS PAC ID | 2466793369 |
|---|---|
| Medicare Enrollment ID | O20190402001670 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518447309 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Secondary |
| Provider Name | Becky Hannowsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669681128 PECOS PAC ID: 9234388208 Enrollment ID: I20121008000183 |
| Provider Name | Kimra Kay Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457744849 PECOS PAC ID: 9830418763 Enrollment ID: I20150427002509 |
| Provider Name | Britt M Borden |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1841251378 PECOS PAC ID: 0345250668 Enrollment ID: I20160204001367 |
| Provider Name | Heather Renee Irelan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881139905 PECOS PAC ID: 0547544280 Enrollment ID: I20170710000085 |
| Provider Name | Wauntesha Hardy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518487677 PECOS PAC ID: 6507136918 Enrollment ID: I20170718001983 |
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