Organization
BLOOMINGTON MEADOWS GP -
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BECKY NYBERG (CFO)
(812) 331-8000
Entity
Organization
Contact information
Practice address
3600 N PROW RD, BLOOMINGTON, IN 47404-1616
(812) 331-8000
(812) 331-8985
Mailing address
3600 N PROW RD, BLOOMINGTON, IN 47404-1616
(812) 331-8000
(812) 331-8985
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
278652298
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200457070A
—
IN
Enumeration date
08/11/2006
Last updated
01/31/2011
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