NPIMap

Organization Active NPI

Living Wellness Respite Retreat

  • Child Mental Illness Respite Care
  • Indianapolis, IN
National Provider Identifier
1053028464
Registry record updated Nov 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child Mental Illness Respite CareTaxonomy code 385HR2055X
Legal business name
LIVING WELLNESS RESPITE RETREAT
Practice address
1531 Wellington Ave
Indianapolis, IN 46219-3844
Phone
(317) 628-0381
NPI assigned
Nov 4, 2022
Last updated
Nov 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dakenya Shae PattersonNPI 1942771290
Title
Co-Owner
Phone
(317) 414-6294

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Child Mental Illness Respite Care 385HR2055X NU Primary

Addresses

Primary practice location

1531 Wellington Ave
Indianapolis, IN 46219-3844

Mailing address

1531 Wellington Ave
Indianapolis, IN 46219-3844
Phone (317) 628-0381

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1053028464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 WELLINGTON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462193844",
            "telephone_number": "317-628-0381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1531 WELLINGTON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462193844",
            "telephone_number": "317-628-0381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WELLNESS RESPITE RETREAT",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-04",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "DAKENYA",
        "authorized_official_middle_name": "SHAE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "317-414-6294"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.