NPIMap

Organization Active NPI

Willowglen Academy - Indiana

  • Adolescent and Children Mental Health Clinic/Center
  • Gary, IN
National Provider Identifier
1487858411
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
53769 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
Jun 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 53769 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.

NPI Registry JSON

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487858411",
    "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": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MUELLER",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "WARREN",
        "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": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "IN",
            "license": "53769",
            "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 Aug 22, 2020; 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.