Active NPI
Madison Center, Inc.
- Psychiatric Residential Treatment Facility
- South Bend, IN
National Provider Identifier
1104974989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric Residential Treatment Facility
- License
- 406-1-PIP
- Legal business name
- MADISON CENTER, INC.
- Practice address
- 403 E Madison St
South Bend, IN 46617-2322 - Phone
- (574) 231-0061
- Fax
- (574) 283-1209
- NPI assigned
- Jan 8, 2007
- Organization subpart
- Yes
- Parent organization
- MADISON CENTER, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brenda J Clanton III
- Title
- Contracts Manager
- Phone
- (574) 283-1107
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Residential Treatment Facility | 323P00000X | 406-1-PIP | IN | Primary |
Addresses
Primary practice location
403 E Madison St
South Bend, IN 46617-2322
Mailing address
403 E Madison St
South Bend, IN 46617-2322
Phone (574) 231-0061
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200495360A | Medicaid | IN |
National Provider Directory
National Provider Directory- Tax ID family
- Madison Center Inc
- Part of
- Madison Center Inc
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- South Bend, IN
- NPI 1174671952
-
- Community/Behavioral Health Agency
- South Bend, IN
- NPI 1265698120
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- South Bend, IN
- NPI 1750411872
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Psychiatric Hospital
- South Bend, IN
- NPI 1073565131
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1270598400000",
"number": "1104974989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 E MADISON ST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466172322",
"telephone_number": "574-231-0061",
"fax_number": "574-283-1209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 E MADISON ST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466172322",
"telephone_number": "574-231-0061",
"fax_number": "574-283-1209"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MADISON CENTER, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MADISON CENTER, INC.",
"enumeration_date": "2007-01-08",
"last_updated": "2010-04-07",
"status": "A",
"authorized_official_last_name": "CLANTON",
"authorized_official_first_name": "BRENDA",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "CONTRACTS MANAGER",
"authorized_official_telephone_number": "574-283-1107",
"authorized_official_name_suffix": "III"
},
"taxonomies": [
{
"code": "323P00000X",
"taxonomy_group": "",
"desc": "Psychiatric Residential Treatment Facility",
"state": "IN",
"license": "406-1-PIP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200495360A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.