Organization
BONNIE-LYN II, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EARLYN PENGELLY M.A., M.S. (CHIEF EXECUTIVE OFFICER)
(507) 388-5801
Entity
Organization
Contact information
Practice address
430 PATTERSON AVE, MANKATO, MN 56001-2309
(507) 388-5801
(507) 388-2715
Mailing address
430 PATTERSON AVE, MANKATO, MN 56001-2309
(507) 388-5801
(507) 388-2715
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120001
UCARE
MN
01
—
30349
HEALTH PARTNERS
MN
01
—
57784BO
BLUE CROSS BLUE SHIELD
MN
01
—
6120605
MEDICA, UBH
MN
Enumeration date
03/23/2007
Last updated
08/22/2020
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