Provider Demographics
NPI:1952022238
Name:FUBE ENTERPRISES, LLC
Entity Type:Organization
Organization Name:FUBE ENTERPRISES, LLC
Other - Org Name:BONTE BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NGUFOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FUBE DIVINE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMH
Authorized Official - Phone:443-230-2285
Mailing Address - Street 1:8210 JEREMIAH LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4165
Mailing Address - Country:US
Mailing Address - Phone:443-230-2285
Mailing Address - Fax:301-368-6675
Practice Address - Street 1:8210 JEREMIAH LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4165
Practice Address - Country:US
Practice Address - Phone:443-230-2285
Practice Address - Fax:301-368-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty