# BLOOMINGTON MEADOWS GP -

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417968595
- **Authorized official:** MS. BECKY NYBERG (CFO)
- **Authorized official phone:** (812) 331-8000

## Contact information

- **Practice address:** 3600 N PROW RD, BLOOMINGTON, IN 47404-1616
- **Practice address phone:** (812) 331-8000
- **Practice address fax:** (812) 331-8985
- **Mailing address:** 3600 N PROW RD, BLOOMINGTON, IN 47404-1616
- **Mailing address phone:** (812) 331-8000
- **Mailing address fax:** (812) 331-8985

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | 278652298 | IN | Yes |

## Other

- **Enumeration date:** 08/11/2006
- **Last updated:** 01/31/2011