# INDIANA CENTER FOR RECOVERY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295276160
- **Authorized official:** MR. KIRILL VESSELOV (PRESIDENT)
- **Authorized official phone:** (561) 461-3791

## Contact information

- **Practice address:** 1004 W 1ST STREET, BLOOMINGTON, IN 47403
- **Practice address phone:** (561) 461-3791
- **Practice address fax:** (888) 516-3613
- **Mailing address:** 1004 W 1ST STREET, BLOOMINGTON, IN 47403
- **Mailing address phone:** (561) 635-2400
- **Mailing address fax:** (888) 516-3613

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | — | NULL | — |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |
| 324500000X | Substance Abuse Rehabilitation Facility | 1759-0ASO | IN | — |
| 324500000X | Substance Abuse Rehabilitation Facility | — | NULL | — |

## Other

- **Enumeration date:** 03/13/2017
- **Last updated:** 04/30/2025