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
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