Organization
INDIANA CENTER FOR RECOVERY ADOLESCENT PROGRAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRILL VESSELOV (PRESIDENT)
(561) 396-5849
Entity
Organization
Contact information
Practice address
215 W 4TH ST, MISHAWAKA, IN 46544-1917
(561) 305-0461
Mailing address
2925 10TH AVE N, PALM SPRINGS, FL 33461-3000
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
06/27/2024
Last updated
01/14/2026
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