Provider Demographics
NPI:1336421270
Name:BASHOR HOME OF THE UNITED METHODIST CHURCH, INC
Entity Type:Organization
Organization Name:BASHOR HOME OF THE UNITED METHODIST CHURCH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-875-5117
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46527-0843
Mailing Address - Country:US
Mailing Address - Phone:574-875-5117
Mailing Address - Fax:574-875-5284
Practice Address - Street 1:62226 COUNTY ROAD 15
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-9438
Practice Address - Country:US
Practice Address - Phone:574-875-5117
Practice Address - Fax:574-875-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty