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NPI Code Detail

MEDICARE: ICR ADOLESCENTS OPERATING SUBSIDIARY, LLC

MEDICARE: ICR ADOLESCENTS OPERATING SUBSIDIARY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13245S0500XChildren's Substance Abuse Rehabilitation Facility
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
3261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1932058369
Entity Type Code : Organization
Provider Name (Legal Business Name) : ICR ADOLESCENTS OPERATING SUBSIDIARY, LLC
Provider Business Mailing Address
First Line : 2925 10TH AVE N
Second Line :
City : PALM SPRINGS
State : FL
Zip : 33461-3000
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 215 W 4TH ST
Second Line :
City : MISHAWAKA
State : IN
Zip : 46544-1917
Country : US
Telephone Number : 574-544-0207
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : TARA GURNEY
Credential :
Telephone Number : 561-517-3400
Provider Enumeration Date : 01/27/2026
Last Update Date : 05/28/2026

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Directions to “ICR ADOLESCENTS OPERATING SUBSIDIARY, LLC ” Practice Location

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