Indiana Center for Recovery, LLC

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

Legal business name

INDIANA CENTER FOR RECOVERY, LLC

Practice address

1004 W 1St Street
Bloomington, IN 47403

Phone

(561) 461-3791

Fax

(888) 516-3613

NPI assigned

Mar 13, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Kirill Vesselov

Title

President

Phone

(561) 461-3791

Specialties & licenses 5

Addresses

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Logan Pfeifer, LCSW, MSW, CDCA

  • Clinical Social Worker
  • Indianapolis, IN
  • NPI 1861927428
  NPD
• Alicia R Simmons, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Brandenburg, KY
  • NPI 1013645431
  NPD
• Jacqueline Daniels, LCSW

  • Clinical Social Worker
  • Bloomington, IN
  • NPI 1205910239
  NPD (past)
• Kyle S Fouch, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Bloomington, IN
  • NPI 1417737396
  NPD (past)
• Michael William Kane, MD

  • Psychiatry Physician
  • Bloomington, IN
  • NPI 1497891840
  NPD (past)
• Melissa Ann Lynch, LCSW

  • Clinical Social Worker
  • Bloomington, IN
  • NPI 1972321057
  NPD (past)
• Lola Isabella Mahner, LCSW

  • Clinical Social Worker
  • Bloomington, IN
  • NPI 1457243420
  NPD (past)

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

{
    "created_epoch": "1489363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745971200000",
    "number": "1295276160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 W 1ST STREET",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47403",
            "telephone_number": "561-635-2400",
            "fax_number": "888-516-3613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 W 1ST STREET",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47403",
            "telephone_number": "561-461-3791",
            "fax_number": "888-516-3613"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 W 1st St",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474032208",
            "country_code": "US",
            "telephone_number": "812-822-2510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "909 W 1st St",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474032274",
            "country_code": "US",
            "telephone_number": "812-822-2510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "421 W 1st St",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474032403",
            "country_code": "US",
            "telephone_number": "561-461-3791",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "637 S Walker St Ste 2",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474032175",
            "country_code": "US",
            "telephone_number": "561-461-3791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INDIANA CENTER FOR RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-13",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A",
        "authorized_official_last_name": "VESSELOV",
        "authorized_official_first_name": "KIRILL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-461-3791",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "IN",
            "license": "1759-0ASO",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric Residential Treatment Facility in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Psychiatric Residential Treatment Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; 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.