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Organization

ICR SOUTH BEND OPERATING SUBSIDIARY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DANIEL MOORE (AUTHORIZED OFFICIAL)
(561) 517-3400
Entity
Organization

Contact information

Practice address
215 W 4TH ST, MISHAWAKA, IN 46544-1917
(574) 544-0207
Mailing address
2925 10TH AVE N, PALM SPRINGS, FL 33461-3000
(305) 361-9115

Taxonomy

Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
283Q00000X
Psychiatric Hospital
Primary
320800000X
Mental Illness Community Based Residential Treatment Facility
323P00000X
Psychiatric Residential Treatment Facility
324500000X
Substance Abuse Rehabilitation Facility

Other

Enumeration date
01/27/2026
Last updated
03/25/2026
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