Provider Demographics
NPI:1215484381
Name:CORNERSTONE OF INDIANAPOLIS, LLC
Entity type:Organization
Organization Name:CORNERSTONE OF INDIANAPOLIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:RODRIGUEZ-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-643-4600
Mailing Address - Street 1:5610 CRAWFORDSVILLE ROAD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224
Mailing Address - Country:US
Mailing Address - Phone:317-429-9201
Mailing Address - Fax:317-672-2264
Practice Address - Street 1:5610 CRAWFORDSVILLE ROAD
Practice Address - Street 2:SUITE 1700
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224
Practice Address - Country:US
Practice Address - Phone:317-643-4600
Practice Address - Fax:317-643-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder