MEDICARE: SUNSTONE HEALTH & WELLNESS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	34006187A	IN

General Provider Information

NPI Number	:	1275920399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSTONE HEALTH & WELLNESS, INC.

Provider Business Mailing Address
First Line	:	1700 W SMITH VALLEY RD STE B4
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1589
Country	:	US
Telephone Number	:	317-886-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 W SMITH VALLEY RD STE B4
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1589
Country	:	US
Telephone Number	:	317-886-1000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LACEY J. RENTSCHLER
Credential	:	MSW
Telephone Number	:	317-886-1000

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	04/16/2015

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