Healthcare Provider Details

I. General information

NPI: 1740140599
Provider Name (Legal Business Name): LIMESTONE TREATMENT & HEALING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 G ST
BEDFORD IN
47421-3827
US

IV. Provider business mailing address

1535 G ST
BEDFORD IN
47421-3827
US

V. Phone/Fax

Practice location:
  • Phone: 812-330-0909
  • Fax:
Mailing address:
  • Phone: 812-330-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA CLARK
Title or Position: ADMINISTRATOR
Credential:
Phone: 812-330-0909