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General NPI Number Information
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NPI Number | 1750851192
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Entity Type | Organization
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Legal Business Name | STIMULI RESIDENTIAL SERVICES
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 6670 KINNERTON DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5843
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Country | US
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Telephone | 317-722-9142
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Fax |
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Provider Business Mailing Address
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Address Line | 6670 KINNERTON DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5843
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Country | US
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Telephone | 317-722-9141
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. BRUNO O OKUJA
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Credential | QIDP
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Telephone | 317-722-9141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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