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NPI Code Detail

MEDICARE: BASHOR HOME OF THE UNITED METHODIST CHURCH, INC

MEDICARE: BASHOR HOME OF THE UNITED METHODIST CHURCH, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1336421270
Entity Type Code : Organization
Provider Name (Legal Business Name) : BASHOR HOME OF THE UNITED METHODIST CHURCH, INC
Provider Business Mailing Address
First Line : PO BOX 843
Second Line :
City : GOSHEN
State : IN
Zip : 46527-0843
Country : US
Telephone Number : 574-875-5117
Fax Number : 574-875-5284
Provider Business Practice Location Address
First Line : 62226 COUNTY ROAD 15
Second Line :
City : GOSHEN
State : IN
Zip : 46526-9438
Country : US
Telephone Number : 574-875-5117
Fax Number : 574-875-5284
Authorized Official
Title or Position : PRESIDENT/CEO
Name : DONALD PHILLIPS
Credential :
Telephone Number : 574-875-5117
Provider Enumeration Date : 09/16/2011
Last Update Date : 01/14/2016

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Directions to “BASHOR HOME OF THE UNITED METHODIST CHURCH, INC ” Practice Location

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