Indiana Center for Recovery Adolescent Program LLC

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

Legal business name

INDIANA CENTER FOR RECOVERY ADOLESCENT PROGRAM LLC

Practice address

215 W 4TH St
Mishawaka, IN 46544-1917

Phone

(561) 305-0461

NPI assigned

Jun 27, 2024

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

President

Phone

(561) 396-5849

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1719446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768348800000",
    "number": "1457196735",
    "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 ADOLESCENT PROGRAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-27",
        "last_updated": "2026-01-14",
        "certification_date": "2026-01-14",
        "status": "A",
        "authorized_official_last_name": "VESSELOV",
        "authorized_official_first_name": "KIRILL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-396-5849"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Icr South Bend Operating Subsidiary, LLC
• Sandy Imanse, LMSW
• Nancy Nasilele Imasiku, MSN, APRN, FNP
• David R Imes, OD
• Denise Dee Imperial, RD
• Indiana Center for Recovery South Bend, LLC
• Indiana Physicians Eyecare Group, P.C.
• Indiana Wellness RX 2 LLC
• Indiana Wellness RX LLC
• Infinity Plus Home Care LLC

• Children's Substance Abuse Rehabilitation Facility in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Children's Substance Abuse Rehabilitation Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2026; 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.