Healthcare Provider Details

I. General information

NPI: 1740856483
Provider Name (Legal Business Name): ROADWAYS TO RECOVERY INC.,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 INDUSTRIAL PARK DRIVE
BEDFORD IN
47421
US

IV. Provider business mailing address

211 STEVENS LN
MITCHELL IN
47446-6606
US

V. Phone/Fax

Practice location:
  • Phone: 812-583-6540
  • Fax: 812-559-9192
Mailing address:
  • Phone: 812-583-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL CORYEA
Title or Position: OWNER
Credential:
Phone: 812-583-6540