Provider Demographics
NPI:1649397092
Name:BONNIE-LYN II, INC.
Entity Type:Organization
Organization Name:BONNIE-LYN II, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:EARLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENGELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MS
Authorized Official - Phone:507-388-5801
Mailing Address - Street 1:430 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-2309
Mailing Address - Country:US
Mailing Address - Phone:507-388-5801
Mailing Address - Fax:507-388-2715
Practice Address - Street 1:430 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-2309
Practice Address - Country:US
Practice Address - Phone:507-388-5801
Practice Address - Fax:507-388-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6120605OtherMEDICA, UBH
MN30349OtherHEALTH PARTNERS
MN120001OtherUCARE
MN57784BOOtherBLUE CROSS BLUE SHIELD