Organization
ICR 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
1004 W 1ST ST, BLOOMINGTON, IN 47403-2208
(812) 393-5596
Mailing address
2925 10TH AVE N, PALM SPRINGS, FL 33461-3000
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
01/29/2026
Last updated
03/25/2026
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