Provider Demographics
NPI:1437301132
Name:BON HOMIE, INC
Entity Type:Organization
Organization Name:BON HOMIE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BLANTON
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEATHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-333-3308
Mailing Address - Street 1:330 W. LEXINGTON AVE
Mailing Address - Street 2:#206
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-2803
Mailing Address - Country:US
Mailing Address - Phone:574-333-3308
Mailing Address - Fax:574-333-3594
Practice Address - Street 1:330 W. LEXINGTON AVE
Practice Address - Street 2:#206
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-2803
Practice Address - Country:US
Practice Address - Phone:574-333-3308
Practice Address - Fax:574-333-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty