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Organization

FAYETTE BHC LLC

Active
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Organization

FAYETTE BHC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TIA R BOWLING (OWNER)
(765) 827-7890
Entity
Organization

Contact information

Practice address
3013 VIRGINIA AVE, CONNERSVILLE, IN 47331-2552
(765) 827-8022
(765) 827-4184
Mailing address
3013 VIRGINIA AVE, CONNERSVILLE, IN 47331-2552
(765) 827-8022
(765) 827-4184

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
310400000X
Assisted Living Facility
363L00000X
Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300082868
IN
Enumeration date
10/16/2023
Last updated
06/30/2025
About Stedi
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