NPIMap

Organization Active NPI

Willowglen Academy - Indiana

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Gary, IN
National Provider Identifier
1417227984
Registry record updated Dec 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
WILLOWGLEN ACADEMY - INDIANA
Practice address
2301 Jefferson St
Gary, IN 46407-3043
Phone
(219) 886-2660
Fax
(219) 886-1319
NPI assigned
Dec 30, 2011
Organization subpart
Yes
Parent organization
PHOENIX CARE SYSTEMS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 30, 2011

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

Authorized official

Name
Ms. Lorene Cameron
Title
Executive Director
Phone
(219) 886-1320

Specialties & licenses 1

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

Addresses

Primary practice location

2301 Jefferson St
Gary, IN 46407-3043

Mailing address

2301 Jefferson St
Gary, IN 46407-3043
Phone (219) 886-2660

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.

NPI Registry JSON

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

{
    "created_epoch": "1325203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325203200000",
    "number": "1417227984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 JEFFERSON ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464073043",
            "telephone_number": "219-886-2660",
            "fax_number": "219-886-1319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 JEFFERSON ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464073043",
            "telephone_number": "219-886-2660",
            "fax_number": "219-886-1319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWGLEN ACADEMY - INDIANA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX CARE SYSTEMS, INC.",
        "enumeration_date": "2011-12-30",
        "last_updated": "2011-12-30",
        "status": "A",
        "authorized_official_last_name": "CAMERON",
        "authorized_official_first_name": "LORENE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "219-886-1320",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "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 Dec 30, 2011; 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.