Organization
ICR ADOLESCENTS 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
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
01/27/2026
Last updated
03/25/2026
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