MEDICARE: FWBH, LLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1750100368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FWBH, LLC

Provider Business Mailing Address
First Line	:	4020 ASPEN GROVE DR STE 900
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-3134
Country	:	US
Telephone Number	:	615-861-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3955 W WASHINGTON CENTER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1526
Country	:	US
Telephone Number	:	317-912-3699
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT AND SECRETARY
Name	:	BRIAN PHILLIP FARLEY
Credential	:
Telephone Number	:	615-861-6000

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	01/20/2026

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