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General NPI Number Information
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NPI Number | 1992781470
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Entity Type | Organization
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Legal Business Name | CENTERSTONE OF INDIANA, INC.
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 645 S ROGERS ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403
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Country | US
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Telephone | 812-339-1691
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Fax | 812-337-2438
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Provider Business Mailing Address
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Address Line | 645 S ROGERS STREET
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2353
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Country | US
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Telephone | 812-339-1691
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Fax | 812-337-2438
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Authorized Official
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Title or Position | CEO
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Name | SUZANNE L KOESEL
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Credential | LCSW
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Telephone | 812-337-2350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 431-049
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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