Provider Demographics
NPI:1669540951
Name:THE CENTER FOR MENTAL HEALTH, INC.
Entity type:Organization
Organization Name:THE CENTER FOR MENTAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DEHAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-641-8281
Mailing Address - Street 1:PO BOX 1258
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46015-1258
Mailing Address - Country:US
Mailing Address - Phone:765-649-8161
Mailing Address - Fax:
Practice Address - Street 1:2020 BROWN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4218
Practice Address - Country:US
Practice Address - Phone:765-649-8161
Practice Address - Fax:765-641-8238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-03
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100277330AMedicaid
INCG1899OtherRAILROAD MEDICARE GROUP NUMBER
IN957350Medicare ID - Type Unspecified
IN509610Medicare ID - Type Unspecified
IN100277330AMedicaid
INCG1899OtherRAILROAD MEDICARE GROUP NUMBER