Provider Demographics
NPI:1770177800
Name:BASTIN HOME INC
Entity type:Organization
Organization Name:BASTIN HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BASTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:513-734-2662
Mailing Address - Street 1:3772 BASS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-9785
Mailing Address - Country:US
Mailing Address - Phone:513-734-2662
Mailing Address - Fax:513-724-2882
Practice Address - Street 1:3772 BASS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-9785
Practice Address - Country:US
Practice Address - Phone:513-734-2662
Practice Address - Fax:513-724-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2000659Medicaid