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NPI Code Detail

MEDICARE: CHARLYN BASILE

MEDICARE: CHARLYN BASILE
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
1106S00000XBehavior TechnicianRBT-15-05078IN

General Provider Information

NPI Number : 1417752049
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLYN BASILE
Provider Business Mailing Address
First Line : 215 RED COACH DR
Second Line :
City : MISHAWAKA
State : IN
Zip : 46545-8307
Country : US
Telephone Number : 574-387-4313
Fax Number : 574-204-2868
Provider Business Practice Location Address
First Line : 2606 VALLEY DR
Second Line :
City : VALPARAISO
State : IN
Zip : 46383-2511
Country : US
Telephone Number : 574-387-4313
Fax Number : 574-204-2868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2025
Last Update Date : 02/18/2025

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Directions to “ CHARLYN BASILE ” Practice Location

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