Organization
INDIANA CENTER FOR RECOVERY OUTPATIENT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRILL VESSELOV (PRESIDENT)
(561) 305-0461
Entity
Organization
Contact information
Practice address
1578 E 85TH AVE, MERRILLVILLE, IN 46410-8900
(561) 305-0461
Mailing address
2925 10TH AVE N, PALM SPRINGS, FL 33461-3000
(561) 305-0461
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
02/13/2023
Last updated
12/14/2023
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