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General NPI Number Information
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NPI Number | 1457539751
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Entity Type | Organization
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Legal Business Name | FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER, INC
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 1000 N BROADWAY
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City | PERU
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State | IN
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Zip | 46970-1070
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Country | US
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Telephone | 574-722-5151
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Fax | 574-739-1414
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Provider Business Mailing Address
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Address Line | 2355 S BUSINESS 31
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City | PERU
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State | IN
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Zip | 46970-8985
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Country | US
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Telephone | 574-722-5151
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Fax | 574-739-1414
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Authorized Official
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Title or Position | CEO
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Name | CARRIE ANN CADWELL
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Credential |
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Telephone | 574-721-3983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 427-1-PIP
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License Number State | IN
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