Indiana Center for Recovery Adolescent Program LLC

NPI #1457196735 in Mishawaka, Indiana

Provider Information

NPI Number: 1457196735
Entity Type: Organization
Organization Name: Indiana Center for Recovery Adolescent Program LLC
Primary Specialty: Substance Abuse Rehabilitation Facility - Substance Abuse Treatment, Children
Enumeration Date: Jun 27, 2024
Last Updated: Jan 14, 2026

Practice Location

Address: 215 W 4TH ST
City: Mishawaka
State: Indiana
ZIP Code: 46544-1917
Phone: (561) 305-0461

Authorized Official

Name: KIRILL VESSELOV
Title: PRESIDENT
Phone: (561) 396-5849

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Adolescent and Children Mental Health — Adolescent and Children Mental Health	261QM0855X
Psychiatric Residential Treatment Facility	323P00000X
Clinic/Center - Rehabilitation, Substance Use Disorder — Rehabilitation, Substance Use Disorder	261QR0405X
Substance Abuse Rehabilitation Facility - Substance Abuse Treatment, Children — Substance Abuse Treatment, Children	3245S0500X	Primary

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