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General NPI Number Information
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NPI Number | 1669254546
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Entity Type | Organization
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Legal Business Name | FAYETTE BHC LLC
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 3013 VIRGINIA AVE
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City | CONNERSVILLE
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State | IN
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Zip | 47331-2552
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Country | US
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Telephone | 765-827-8022
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Fax | 765-827-4184
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Provider Business Mailing Address
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Address Line | 3013 VIRGINIA AVE
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City | CONNERSVILLE
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State | IN
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Zip | 47331-2552
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Country | US
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Telephone | 765-827-8022
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Fax | 765-827-4184
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Authorized Official
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Title or Position | OWNER
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Name | TIA R BOWLING
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Credential |
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Telephone | 765-827-7890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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