# ADDICTION WELLNESS CENTER IN LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ADDICTION WELLNESS CENTER IN LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1740197136
- **Legal business name:** ADDICTION WELLNESS CENTER IN LLC
- **Authorized official:** JESSIE COSTLEY (CREDENTIALING MANAGER)
- **Authorized official phone:** (443) 452-3149

## Contact information

- **Practice address:** 202 E MAPLE ST, JEFFERSONVILLE, IN 47130-3420
- **Practice address phone:** (812) 850-0619
- **Practice address fax:** (317) 458-1794
- **Mailing address:** 1100 BUSINESS PKWY S STE 1, WESTMINSTER, MD 21157-3048
- **Mailing address phone:** (812) 850-0619
- **Mailing address fax:** (317) 458-1794

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/24/2026
- **Last updated:** 08/24/2026