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Organization Active NPI

Willowglen Academy - Indiana

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Gary, IN
National Provider Identifier
1073788113
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
33456 Issued in IN
Legal business name
WILLOWGLEN ACADEMY - INDIANA
Practice address
308 E 21St Ave
Gary, IN 46407-2618
Phone
(219) 886-1320
NPI assigned
Apr 29, 2008
Organization subpart
Yes
Parent organization
PHONENIX CARE SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Mr. Dwayne W Mueller, RN
Title
Executive Director
Phone
(219) 886-1320

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 33456 IN Primary

Addresses

Primary practice location

308 E 21St Ave
Gary, IN 46407-2618

Mailing address

308 E 21St Ave
Gary, IN 46407-2618
Phone (219) 886-1320

National Provider Directory

National Provider Directory
Tax ID family
Willowglen Academy - Indiana6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

308 E 21st Ave
Gary, IN 46407
Phone (219) 588-3176

NPI Registry JSON

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1073788113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 E 21ST AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464072618",
            "telephone_number": "219-886-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 E 21ST AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464072618",
            "telephone_number": "219-886-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWGLEN ACADEMY - INDIANA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHONENIX CARE SYSTEM",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "MUELLER",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "219-886-1320",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "IN",
            "license": "33456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gary, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.