Provider Demographics
NPI:1538514344
Name:ADULT AND CHILD MENTAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:ADULT AND CHILD MENTAL HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-882-5122
Mailing Address - Street 1:222 E OHIO ST STE 600
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2169
Mailing Address - Country:US
Mailing Address - Phone:317-275-8817
Mailing Address - Fax:317-632-6148
Practice Address - Street 1:8404 SIEAR TER STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7201
Practice Address - Country:US
Practice Address - Phone:877-882-5122
Practice Address - Fax:317-888-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201387680Medicaid