Healthcare Provider Details

I. General information

NPI: 1982574604
Provider Name (Legal Business Name): WILLOW TREATMENT AND RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 MADISON AVE STE 100
INDIANAPOLIS IN
46227-1383
US

IV. Provider business mailing address

3919 MADISON AVE STE 100
INDIANAPOLIS IN
46227-1383
US

V. Phone/Fax

Practice location:
  • Phone: 317-852-3690
  • Fax: 317-852-2790
Mailing address:
  • Phone: 317-852-3690
  • Fax: 317-852-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: ASHLEY S ENGLISH
Title or Position: CEO
Credential:
Phone: 317-852-3690