Healthcare Provider Details

I. General information

NPI: 1912810466
Provider Name (Legal Business Name): CENTERSTONE HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 N STATE ST STE A
NORTH VERNON IN
47265-1453
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 812-979-0420
  • Fax: 812-314-3671
Mailing address:
  • Phone: 812-269-5092
  • Fax: 812-269-5095

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