Indiana Center for Recovery South Bend, LLC

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

Legal business name

INDIANA CENTER FOR RECOVERY SOUTH BEND, LLC

Doing business as

Hoosier Wellness Providers

Practice address

215 W 4TH St
Mishawaka, IN 46544-1917

Phone

(561) 305-0461

NPI assigned

Jan 21, 2022

Organization subpart

No

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

Authorized official

Name

Kirill Vesselov

Title

Ceo

Phone

(561) 305-0461

Specialties & licenses 5

Addresses

Other names 1

• Hoosier Wellness Providers Doing business as

Locations

Practitioners 4

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

• Melissa Boyll, LSW

  • Counselor
  • Mishawaka, IN
  • NPI 1003493461
  NPD (past)
• Jacqueline Brown, LCSW

  • Clinical Social Worker
  • South Bend, IN
  • NPI 1386872448
  NPD (past)
• Dawn Marie Johnson, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Mishawaka, IN
  • NPI 1467936070
  NPD (past)
• Michael William Kane, MD

  • Psychiatry Physician
  • Bloomington, IN
  • NPI 1497891840
  NPD (past)

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

{
    "created_epoch": "1642723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1326790262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 10TH AVE N",
            "city": "PALM SPRINGS",
            "state": "FL",
            "postal_code": "334613000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W 4TH ST",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441917",
            "telephone_number": "561-305-0461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA CENTER FOR RECOVERY SOUTH BEND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-21",
        "last_updated": "2025-09-02",
        "certification_date": "2025-03-19",
        "status": "A",
        "authorized_official_last_name": "VESSELOV",
        "authorized_official_first_name": "KIRILL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-305-0461"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "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": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hoosier Wellness Providers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sandy Imanse, LMSW
• Nancy Nasilele Imasiku, MSN, APRN, FNP
• David R Imes, OD
• Denise Dee Imperial, RD
• Indiana Center for Recovery Adolescent Program LLC
• Indiana Physicians Eyecare Group, P.C.
• Indiana Wellness RX 2 LLC
• Indiana Wellness RX LLC
• Infinity Plus Home Care LLC
• Bryce Jacob Ingram

• Psychiatric Hospital in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Psychiatric Hospital in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 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.