NPIMap

Organization Active NPI

Four County Comprehensive Mental Health Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Peru, IN
National Provider Identifier
1972545945
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
427-0-CMHC Issued in IN
Legal business name
FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER INC
Practice address
1000 N Broadway
Peru, IN 46970-1070
Phone
(574) 722-5151
Fax
(574) 739-1414
NPI assigned
Jun 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Authorized official

Name
Carrie Ann Cadwell, HSPP
Title
Ceo
Phone
(574) 722-5151

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 427-0-CMHC IN Primary
Rehabilitation Clinic/Center 261QR0400X 427-0-CMHC IN

Addresses

Primary practice location

1000 N Broadway
Peru, IN 46970-1070

Mailing address

2355 S Business 31
Peru, IN 46970-8985
Phone (574) 722-5151

Other practice location 1

1015 Michigan Ave
Logansport, IN 46947-1527
Phone (574) 722-5151

Other identifiers 1

IdentifierTypeStateIssuer
100464740MedicaidIN

Other names 1

  • 4C Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000480 IN Part B Supplier - Clinic/Group Practice 2163334277 Receives reassigned benefits from 54 practitioners
Practice locations: Tipton, IN; Winamac, IN; Rochester, IN; Peru, IN; Monticello, IN; Logansport, IN; Kokomo, IN

National Provider Directory

National Provider Directory

Locations

3002 E Wabash St
Frankfort, IN 46041

2796 N Apperson Way
Kokomo, IN 46901

421 12th St
Logansport, IN 46947
Phone (574) 722-7407

1 Landis Ln
Logansport, IN 46947

1 Zebra Ln
Rochester, IN 46975
Phone (574) 223-2159

417 S Chicago St
Royal Center, IN 46978

619 S Main St
Tipton, IN 46072

2418 Curtis Dr
Winamac, IN 46996
Phone (219) 946-7710

Practitioners & affiliated clinicians

Practitioners 59

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 59

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1972545945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 S BUSINESS 31",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469708985",
            "telephone_number": "574-722-5151",
            "fax_number": "574-739-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N BROADWAY",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469701070",
            "telephone_number": "574-722-5151",
            "fax_number": "574-739-1414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1015 Michigan Ave",
            "address_purpose": "LOCATION",
            "city": "Logansport",
            "state": "IN",
            "postal_code": "469471527",
            "country_code": "US",
            "telephone_number": "574-722-5151",
            "fax_number": "574-739-1414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "CADWELL",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "574-722-5151",
        "authorized_official_credential": "HSPP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IN",
            "license": "427-0-CMHC",
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "IN",
            "license": "427-0-CMHC",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100464740",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "4C Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peru, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.