Astrum Wellness and Recovery LLC
Organization Active NPI Addiction Medicine (Preventive Medicine) Physician · Fort Wayne, IN
NPI 1801575972 · NPPES record last updated Jul 14, 2023
Key facts
- NPI
- 1801575972
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Addiction Medicine (Preventive Medicine) Physician 2083A0300X
- Legal business name
- ASTRUM WELLNESS AND RECOVERY LLC
- Practice address
- 129 E Dewald St
Fort Wayne, IN 46803-3317 - Phone
- (260) 280-3341
- NPI assigned
- Jul 14, 2023
- Organization subpart
- No
Authorized official
- Name
- Kimberly Latibeaudier
- Title
- Co Director
- Phone
- (260) 280-3341
Practitioners 5
-
Kristen Elaine Bell, FNP, BC
-
Wendy Jo Dabb, NP
-
Pamela Kinder Fountain, MSN, RNC, APRN-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240104003012 | IN | Part B Supplier - Clinic/Group Practice | 4981055894 |
Receives reassigned benefits from 5 practitioners Practice locations: Fort Wayne, IN |
National Provider Directory
Locations
3340 Mallard Cove Ln
Fort Wayne, IN 46804
Phone (317) 608-7856
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Preventive Medicine) Physician |
2083A0300X | Yes |
Addresses
Primary practice location
129 E Dewald St
Fort Wayne, IN 46803-3317
Mailing address
2712 N Wells St
Fort Wayne, IN 46808-2102
Phone (317) 608-7856
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- Jennifer Asuquo
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All providers in Fort Wayne, IN · Addiction Medicine (Preventive Medicine) Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.