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ICR SOUTH BEND OPERATING SUBSIDIARY, LLC
NPI 1093664435
Psychiatric Hospital in Mishawaka, IN

Active since January 27, 2026CLIA 15D2254437 · Waiver
215 W 4TH ST, MISHAWAKA, IN 46544(574) 544-0207 Get Directions Write a Review

NPPES record last updated: May 28, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 28, 2026, Mar 25, 2026, Jan 27, 2026 (3 updates tracked since 2026).

About Icr South Bend Operating Subsidiary, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ICR SOUTH BEND OPERATING SUBSIDIARY, LLC (NPI 1093664435) is a healthcare organization registered as a psychiatric hospital in Mishawaka, Indiana and active in the NPI registry since January 2026. The organization holds a CLIA Waiver certificate valid through March 2, 2028 and lists Tara Gurney, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1093664435
Entity TypeOrganization
Primary Taxonomy283Q00000X
Legal Business NameICR SOUTH BEND OPERATING SUBSIDIARY, LLC
Location Address215 W 4TH STMishawaka, IN 46544-1917
Mailing Address2925 10th Ave NPalm Springs, FL 33461-3000 · (305) 361-9115
Phone(574) 544-0207
Organization SubpartNo
Authorized OfficialTara GurneyAuthorized Official · (561) 517-3400
Enumeration DateJanuary 27, 2026
Last NPPES UpdateMay 28, 20263 updates tracked since enumeration
NPPES CertifiedMay 28, 2026
✔ NPI 1093664435 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyPsychiatric HospitalHospitals
Taxonomy Code283Q00000X
Definition
An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings.
Also ListedClinic/Center · Adult Mental HealthTaxonomy 261QM0850X
Also ListedCommunity Based Residential Treatment Facility, Mental IllnessTaxonomy 320800000X
Also ListedPsychiatric Residential Treatment FacilityTaxonomy 323P00000X
Also ListedSubstance Abuse Rehabilitation FacilityTaxonomy 324500000X
215 W 4TH ST, Mishawaka, IN 46544
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D2254437

Icr South Bend Operating Subsidiary, LLC · Mishawaka, IN
Active · expires Mar 2, 2028
CLIA Number15D2254437
Laboratory TypeSubstance Abuse Facility
Certificate Effective DateMarch 3, 2026
Certificate Expiration DateMarch 2, 2028
Laboratory DirectorMichael Kane
Laboratory Phone(561) 307-1212
Laboratory LocationIcr South Bend Operating Subsidiary, LLC215 West 4th Street, Mishawaka, IN 46544
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RIVER BEND ANESTHESIA, LLC
Anesthesiology
215 W 4TH ST
MISHAWAKA, IN 46544
St. Joseph County (574) 271-0013
SCCI HOSPITALS OF AMERICA, LLC
Long Term Care Hospital
215 W 4TH ST
MISHAWAKA, IN 46544
St. Joseph County (574) 251-8238
SELECT SPECIALTY HOSPITAL - NORTHERN INDIANA, LLC
Long Term Care Hospital
215 W 4TH ST, 2ND FLOOR
MISHAWAKA, IN 46544
St. Joseph County (717) 972-1100
INDIANA CENTER FOR RECOVERY SOUTH BEND, LLC
Psychiatric Hospital
215 W 4TH ST
MISHAWAKA, IN 46544
St. Joseph County (561) 305-0461
SELECT SPECIALTY HOSPITAL - NORTHERN INDIANA, LLC
Hospitalist
215 W 4TH ST, 2ND FL
MISHAWAKA, IN 46544
St. Joseph County (717) 972-1100
SOUND PHYSICIANS OF INDIANA, LLC
Hospitalist
215 W 4TH ST, # 200
MISHAWAKA, IN 46544
St. Joseph County (574) 252-2000
LESLY STEWART PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
215 W 4TH ST
MISHAWAKA, IN 46544
St. Joseph County (574) 544-0101
INDIANA CENTER FOR RECOVERY ADOLESCENT PROGRAM LLC
Substance Abuse Rehabilitation Facility (Substance Abuse Treatment, Children)
215 W 4TH ST
MISHAWAKA, IN 46544
St. Joseph County (561) 305-0461

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Icr South Bend Operating Subsidiary, LLC's NPI number?

The NPI number for Icr South Bend Operating Subsidiary, LLC is 1093664435. It was assigned to this organization in the NPPES registry on January 27, 2026.

Where is Icr South Bend Operating Subsidiary, LLC located?

Icr South Bend Operating Subsidiary, LLC is located at 215 W 4th St, Mishawaka, IN 46544. The listed phone number is (574) 544-0207.

What is Icr South Bend Operating Subsidiary, LLC's specialty?

The primary specialty registered for this NPI is Psychiatric Hospital with taxonomy code 283Q00000X.

Does Icr South Bend Operating Subsidiary, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2254437) is associated with this NPI, valid through March 2, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Icr South Bend Operating Subsidiary, LLC was last updated on May 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.