Organization
INDIANA CENTER FOR RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIRILL VESSELOV (PRESIDENT)
(561) 461-3791
Entity
Organization
Contact information
Practice address
1004 W 1ST STREET, BLOOMINGTON, IN 47403
(561) 461-3791
(888) 516-3613
Mailing address
1004 W 1ST STREET, BLOOMINGTON, IN 47403
(561) 635-2400
(888) 516-3613
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
1759-0ASO
IN
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
03/13/2017
Last updated
04/30/2025
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