Healthcare Provider Details

I. General information

NPI: 1114553948
Provider Name (Legal Business Name): CENTERSTONE HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N MARR RD STE A
COLUMBUS IN
47201-6660
US

IV. Provider business mailing address

645 S ROGERS ST STE A
BLOOMINGTON IN
47403-2353
US

V. Phone/Fax

Practice location:
  • Phone: 812-314-3400
  • Fax: 812-376-4875
Mailing address:
  • Phone: 812-339-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JENNY HARRISON
Title or Position: CEO
Credential:
Phone: 812-350-8249