Healthcare Provider Details

I. General information

NPI: 1730240888
Provider Name (Legal Business Name): STONE BELT ARC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S ADAMS ST
BLOOMINGTON IN
47403-2165
US

IV. Provider business mailing address

2815 E 10TH ST
BLOOMINGTON IN
47408-2601
US

V. Phone/Fax

Practice location:
  • Phone: 812-333-6324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH DEWEES
Title or Position: CEO
Credential:
Phone: 812-332-2168