Healthcare Provider Details

I. General information

NPI: 1538514344
Provider Name (Legal Business Name): ADULT AND CHILD MENTAL HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 01/13/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 MADISON AVE
INDIANAPOLIS IN
46227-6066
US

IV. Provider business mailing address

222 E OHIO ST STE 600
INDIANAPOLIS IN
46204-2169
US

V. Phone/Fax

Practice location:
  • Phone: 317-882-5122
  • Fax: 317-888-8642
Mailing address:
  • Phone: 317-275-8817
  • Fax: 317-632-6148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA R CARTER
Title or Position: VP MANAGED CARE
Credential:
Phone: 417-761-5126