# WILLOWGLEN ACADEMY - INDIANA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PHONENIX CARE SYSTEM
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073788113
- **Legal business name:** PHONENIX CARE SYSTEM
- **Authorized official:** MR. DWAYNE W MUELLER RN (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (219) 886-1320

## Contact information

- **Practice address:** 308 E 21ST AVE, GARY, IN 46407-2618
- **Practice address phone:** (219) 886-1320
- **Mailing address:** 308 E 21ST AVE, GARY, IN 46407-2618
- **Mailing address phone:** (219) 886-1320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 33456 | IN | Yes |

## Other

- **Enumeration date:** 04/29/2008
- **Last updated:** 06/17/2008