1437301132 NPI number — BON HOMIE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437301132 NPI number — BON HOMIE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BON HOMIE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437301132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 W. LEXINGTON AVE
Provider Second Line Business Mailing Address:
#206
Provider Business Mailing Address City Name:
ELKHART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46516-2803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-333-3308
Provider Business Mailing Address Fax Number:
574-333-3594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 W. LEXINGTON AVE
Provider Second Line Business Practice Location Address:
#206
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46516-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-333-3308
Provider Business Practice Location Address Fax Number:
574-333-3594
Provider Enumeration Date:
10/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BEATHEA
Authorized Official First Name:
BLANTON
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
574-333-3308

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)