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General NPI Number Information
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NPI Number | 1336421270
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Entity Type | Organization
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Legal Business Name | BASHOR HOME OF THE UNITED METHODIST CHURCH, INC
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 62226 COUNTY ROAD 15
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City | GOSHEN
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State | IN
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Zip | 46526-9438
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Country | US
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Telephone | 574-875-5117
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Fax | 574-875-5284
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Provider Business Mailing Address
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Address Line | PO BOX 843
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City | GOSHEN
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State | IN
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Zip | 46527-0843
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Country | US
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Telephone | 574-875-5117
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Fax | 574-875-5284
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DONALD PHILLIPS
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Credential |
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Telephone | 574-875-5117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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