# FAYETTE BHC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538932140
- **Authorized official:** JESSIE COSTLEY (DIRECTOR OF PROVIDER ENROLLMENT)
- **Authorized official phone:** (443) 839-6928

## Contact information

- **Practice address:** 450 ERIE AVE, CONNERSVILLE, IN 47331-3176
- **Practice address phone:** (765) 827-8022
- **Mailing address:** 450 ERIE AVE, CONNERSVILLE, IN 47331-3176

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |
| 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