NPIMap

Organization Active NPI

Intercare Community Health Network

Doing business as InterCare Child and Adolescent Behavioral Health Center

  • Federally Qualified Health Center (FQHC)
  • Eau Claire, MI
National Provider Identifier
1336701119
Registry record updated Jul 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INTERCARE COMMUNITY HEALTH NETWORK
Doing business as
InterCare Child and Adolescent Behavioral Health Center
Practice address
7450 Hochberger Rd RM 15a
Eau Claire, MI 49111-9762
Phone
(269) 461-6947
NPI assigned
Jul 2, 2019
Last updated
Jul 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Velma Hendershott
Title
Ceo/President
Phone
(269) 427-7937

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
School Counselor 101YS0200X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

7450 Hochberger Rd RM 15a
Eau Claire, MI 49111-9762

Mailing address

50 Industrial Park Rd
Bangor, MI 49013-1246
Phone (269) 427-7937

Other names 1

  • InterCare Child and Adolescent Behavioral Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190912002295 MI Part A Provider - Federally Qualified Health Center (FQHC) 9537061254 Practice locations: Eau Claire, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336701119. Details of each certification follow.

Federally qualified health center certification: CCN 231142

Legal name
INTERCARE COMMUNITY HEALTH NETWORK
Doing business as
INTERCARE CHILD AND ADOLESCENT BEHAVIORAL HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 11, 2019
Last certification
Sep 11, 2019
Ownership / control type
For profit – corporation
Organization structure
OtherProprietary
Incorporated
Sep 1, 1971 in MI
Enrollment address
7450 Hochberger Rd
RM 15a
Eau Claire, MI 49111-9762

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Intercare Community Health Network16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

697 Weld St
Benton Harbor, MI 49022
Phone (269) 927-5300

870 Colfax Ave
Benton Harbor, MI 49022
Phone (269) 605-1277

7450 Hochberger Rd
Rm 15A
Eau Claire, MI 49111
Phone (269) 461-6947

5498 109th Ave
Pullman, MI 49450
Phone (269) 236-5021

11637 M 140
South Haven, MI 49090
Phone (616) 637-3528

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ron Karpanty Individual Corporate DirectorBoard Director - Vice Chair Jan 1, 2019
Velma Hendershot Individual Corporate OfficerCeo/President Jan 1, 1987
Corporate DirectorCeo/President Jan 1, 1987
Margaret Adams Individual Corporate DirectorBoard Member May 19, 2015
Karen Freeburn Individual Corporate DirectorBoard Director-Chair Jan 1, 2002
John McElwee Individual Corporate DirectorCfo Nov 20, 2023
W-2 Managing EmployeeCfo Nov 20, 2023

Practitioners & affiliated clinicians

Practitioners 105

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 105

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562025600000",
    "number": "1336701119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 INDUSTRIAL PARK RD",
            "city": "BANGOR",
            "state": "MI",
            "postal_code": "490131246",
            "telephone_number": "269-427-7937",
            "fax_number": "269-427-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7450 HOCHBERGER RD RM 15A",
            "city": "EAU CLAIRE",
            "state": "MI",
            "postal_code": "491119762",
            "telephone_number": "269-461-6947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCARE COMMUNITY HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-02",
        "last_updated": "2019-07-02",
        "status": "A",
        "authorized_official_last_name": "HENDERSHOTT",
        "authorized_official_first_name": "VELMA",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "269-427-7937"
    },
    "taxonomies": [
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "InterCare Child and Adolescent Behavioral Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eau Claire, MI

Sources for this page

Verify at the official NPI Registry.