Organization
STONE BELT ARC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE GREEN (CEO)
(812) 332-2168
Entity
Organization
Contact information
Practice address
4417 E BLACKSTONE CT, BLOOMINGTON, IN 47408-3181
(812) 339-8284
Mailing address
2815 E 10TH ST, BLOOMINGTON, IN 47408-2601
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
00000704IDE07
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100234540
—
IN
Enumeration date
12/14/2006
Last updated
12/20/2013
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