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Organization
FAYETTE BHC LLC
Active
Organization
FAYETTE BHC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE COSTLEY (DIRECTOR OF PROVIDER ENROLLMENT)
(443) 839-6928
Entity
Organization
Contact information
Practice address
450 ERIE AVE, CONNERSVILLE, IN 47331-3176
(765) 827-8022
Mailing address
450 ERIE AVE, CONNERSVILLE, IN 47331-3176
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
NULL
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
NULL
324500000X
Substance Abuse Rehabilitation Facility
—
NULL
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
NULL
Other
Enumeration date
11/06/2023
Last updated
03/20/2024
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