Provider Demographics
NPI:1750851192
Name:STIMULI RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:STIMULI RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:O
Authorized Official - Last Name:OKUJA
Authorized Official - Suffix:
Authorized Official - Credentials:QIDP
Authorized Official - Phone:317-722-9141
Mailing Address - Street 1:6670 KINNERTON DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5843
Mailing Address - Country:US
Mailing Address - Phone:317-722-9141
Mailing Address - Fax:
Practice Address - Street 1:6670 KINNERTON DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5843
Practice Address - Country:US
Practice Address - Phone:317-722-9142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIMedicaid