WILLOWGLEN ACADEMY - INDIANA (NPI# 1144353715) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144353715 |
| Entity Type | Organization |
| Organization Name | WILLOWGLEN ACADEMY - INDIANA |
| Practice Address |
308 E 21st Ave Gary IN 46407-2618 |
| Practice Telephone | 2198861320 |
| Practice Fax Number | 2198861319 |
| Mailing Telephone | 2198861320 |
| Mailing Fax Number | 2198861319 |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. DWAYNE WARREN MUELLER (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2198861320 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 33456 | IN | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417227984 | Willowglen Academy - Indiana | Residential Treatment Facility, Emotionally Disturbed Children | 2301 Jefferson St, Gary, IN 46407-3043 | 2011-12-30 |
| 1073788113 | Willowglen Academy - Indiana | Residential Treatment Facility, Emotionally Disturbed Children | 308 E 21st Ave, Gary, IN 46407-2618 | 2008-04-29 |
| 1487858411 | Willowglen Academy - Indiana | Clinic/Center | 308 E 21st Ave, Gary, IN 46407-2618 | 2007-06-13 |
| Street Address |
308 E 21ST AVE |
| City | GARY |
| State | IN |
| Zip Code | 46407-2618 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376974246 | Willowglen Academy-in, Inc. | Social Worker | 308 E 21st Ave, Gary, IN 46407-2618 | 2013-12-03 |
| 1023339587 | Tashena R Lollis | Social Worker | 308 E 21st Ave, Gary, IN 46407-2618 | 2010-06-18 |
| 1194046698 | Bunnie J Fleming | Licensed Practical Nurse | 308 E 21st Ave, Gary, IN 46407-2618 | 2010-06-18 |
| 1750602355 | Kecia Marie Blakely | Psychologist | 308 E 21st Ave, Gary, IN 46407-2618 | 2010-06-17 |
| 1790006302 | Darlene Roseta Tolbert | Registered Nurse | 308 E 21st Ave, Gary, IN 46407-2618 | 2010-06-17 |
| 1073834875 | Marilyn M. Caruthers | Social Worker | 308 E 21st Ave, Gary, IN 46407-2618 | 2010-06-15 |
| 1073788113 | Willowglen Academy - Indiana | Residential Treatment Facility, Emotionally Disturbed Children | 308 E 21st Ave, Gary, IN 46407-2618 | 2008-04-29 |
| 1730384207 | Alexis Nelson | Social Worker | 308 E 21st Ave, Gary, IN 46407-2618 | 2007-06-15 |
| 1598960064 | Terald Blakey | Counselor | 308 E 21st Ave, Gary, IN 46407-2618 | 2007-06-15 |
| 1720283278 | Pamela Gabor | Social Worker | 308 E 21st Ave, Gary, IN 46407-2618 | 2007-06-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477802270 | Planned Parenthood of Indiana Gary | Clinic/Center | 1124 Broadway, Gary, IN 46407 | 2012-09-07 |
| 1891930913 | Angela Juanita Anderson | General Practice | 2353 Madison Street, Gary, IN 46407 | 2008-12-03 |
| 1548470537 | Rae Emerick | Speech-Language Pathologist | 2350 Taft Street, Gary, IN 46407 | 2007-05-22 |
| 1467577049 | Lavearn May | Registered Nurse | 308 E. 21st Avenue, Gary, IN 46407 | 2007-03-20 |
| 1881719532 | Kenneth Hicks | Social Worker | 308 East 21st Avenue, Gary, IN 46407 | 2007-03-20 |
| 1356476287 | Chube Medical Corporation | Family Medicine | 1701 Broadway, Gary, IN 46407 | 2007-02-22 |
| 1346263217 | Pulaski Memorial Hospital | Nursing Facility/Intermediate Care Facility | 700 E 21st Ave, Gary, IN 46407 | 2006-07-25 |
| 1477042505 | Ileana Green | Nurse Practitioner | 1400 Broadway, Gary, IN 46407 | 2018-05-03 |
| 1275734949 | Kenneth Edward Anderson | Speech-Language Pathologist | 2350 Taft St, Timberview Health Care Center, Gary, IN 46407 | 2007-05-30 |
| 1669555991 | David D Chube Sr. | Family Medicine | 1701 Broadway, Gary, IN 46407 | 2006-10-23 |
| Find all providers in zip 46407 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417227984 | Willowglen Academy - Indiana | Residential Treatment Facility, Emotionally Disturbed Children | 2301 Jefferson St, Gary, IN 46407-3043 | 2011-12-30 |
| 1639593247 | Crisis Center Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 101 N Montgomery St, Gary, IN 46403-3921 | 2014-02-18 |
| 1073788113 | Willowglen Academy - Indiana | Residential Treatment Facility, Emotionally Disturbed Children | 308 E 21st Ave, Gary, IN 46407-2618 | 2008-04-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811206493 | Shults-lewis Child and Family Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 325 South 150 East, Valparaiso, IN 46383-7866 | 2010-09-30 |
| 1336454552 | Wernle Youth & Family Treatment Center | Residential Treatment Facility, Emotionally Disturbed Children | 2000 Wernle Rd, Richmond, IN 47374-7015 | 2010-08-12 |
| 1730494360 | Resource Community Based Services Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1404 S State Ave, Indianapolis, IN 46203-2009 | 2010-08-06 |
| 1356671192 | Sequel Tsi of Indiana, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2426 S Parker Ln, Lexington, IN 47138-8561 | 2009-12-29 |
| 1578897773 | Open Arms Christian Ministries, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 4516 W State Road 54, Bloomfield, IN 47424-5207 | 2009-09-22 |
| 1871749119 | Gibault, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 6301 S Us Highway 41, Terre Haute, IN 47802-4771 | 2008-08-18 |
| 1528285897 | St. Joseph Home for Boys, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 4007 S Sheffield Ave, Hammond, IN 46327-1242 | 2007-04-19 |
| 1861587230 | Success Acq Corp | Residential Treatment Facility, Emotionally Disturbed Children | 3455 West Vermont, Indianapolis, IN 46222 | 2006-10-03 |
| 1699868893 | Crossroad - Fort Wayne Childrens Home | Residential Treatment Facility, Emotionally Disturbed Children | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2006-10-02 |
| 1740373323 | Options Treatment Acquisition Corporation | Residential Treatment Facility, Emotionally Disturbed Children | 5602 Caito Drive, Indianapolis, IN 46226 | 2006-10-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.