ICR ADOLESCENTS OPERATING SUBSIDIARY, LLC
NPI 1932058369
Substance Abuse Rehabilitation Facility - Substance Abuse Treatment, Children in Mishawaka, IN
About Icr Adolescents Operating Subsidiary, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ICR ADOLESCENTS OPERATING SUBSIDIARY, LLC (NPI 1932058369) is a healthcare organization registered as a substance abuse treatment, children in Mishawaka, Indiana and active in the NPI registry since January 2026. The organization holds a CLIA Waiver certificate valid through November 5, 2026 and lists Tara Gurney, Authorized Official, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 4
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 15D2313729
Icr Adolescents Operating Subsidiary, LLC · Mishawaka, INOther Providers at the Same Location NPPES 19
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MISHAWAKA, IN 46544
MISHAWAKA, IN 46544
MISHAWAKA, IN 46544
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 Adolescents Operating Subsidiary, LLC's NPI number?
The NPI number for Icr Adolescents Operating Subsidiary, LLC is 1932058369. It was assigned to this organization in the NPPES registry on January 27, 2026.
Where is Icr Adolescents Operating Subsidiary, LLC located?
Icr Adolescents Operating Subsidiary, LLC is located at 215 W 4th St, Mishawaka, IN 46544. The listed phone number is (574) 544-0207.
What is Icr Adolescents Operating Subsidiary, LLC's specialty?
The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility, specializing in Substance Abuse Treatment, Children, with taxonomy code 3245S0500X.
Does Icr Adolescents Operating Subsidiary, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 15D2313729) is associated with this NPI, valid through November 5, 2026. 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 Adolescents Operating Subsidiary, LLC was last updated on July 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 36 days 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.
# Icr Adolescents Operating Subsidiary, Llc · NPI 1932058369
Substance Abuse Treatment, Children organization in Mishawaka, Indiana. Organization record, active in the CMS NPPES registry since January 27, 2026.
## Identity
- **NPI:** 1932058369 (Entity type: Organization)
- **Enumerated:** January 27, 2026
- **Primary specialty:** Substance Abuse Rehabilitation Facility - Substance Abuse Treatment, Children · taxonomy 3245S0500X
- **Organization subpart:** No
- **Authorized official:** Tara Gurney, AUTHORIZED OFFICIAL
## Practice location
- **Address:** 215 W 4TH ST, Mishawaka, IN 46544-1917
- **Phone:** (574) 544-0207
## Record status
- **NPPES last updated:** July 10, 2026
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1932058369) · Data from the CMS NPPES public registry.