Organization
WILLOWGLEN ACADEMY - INDIANA
Active
Parent organization
PHONENIX CARE SYSTEM
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHONENIX CARE SYSTEM
Authorized official
MR. DWAYNE W MUELLER RN (EXECUTIVE DIRECTOR)
(219) 886-1320
Entity
Organization
Contact information
Practice address
308 E 21ST AVE, GARY, IN 46407-2618
(219) 886-1320
Mailing address
308 E 21ST AVE, GARY, IN 46407-2618
(219) 886-1320
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
33456
IN
Other
Enumeration date
04/29/2008
Last updated
06/17/2008
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