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General NPI Number Information
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NPI Number | 1972545945
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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 | 06/12/2006
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Last Update Date | 09/18/2024
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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 | HSPP
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Telephone | 574-722-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 427-0-CMHC
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 427-0-CMHC
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License Number State | IN
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