Provider Demographics
NPI: | 1114553948 |
---|---|
Name: | CENTERSTONE HEALTH SERVICES, INC |
Entity Type: | Organization |
Organization Name: | CENTERSTONE HEALTH SERVICES, INC |
Other - Org Name: | CENTERSTONE HEALTH SERVICES, INC. |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JENNY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HARRISON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 812-350-8249 |
Mailing Address - Street 1: | 645 S ROGERS ST STE A |
Mailing Address - Street 2: | |
Mailing Address - City: | BLOOMINGTON |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 47403-2353 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 812-339-1691 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 720 N MARR RD STE A |
Practice Address - Street 2: | |
Practice Address - City: | COLUMBUS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 47201-6660 |
Practice Address - Country: | US |
Practice Address - Phone: | 812-314-3400 |
Practice Address - Fax: | 812-376-4875 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-03-12 |
Last Update Date: | 2024-03-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |