Healthcare Provider Details

I. General information

NPI: 1720423205
Provider Name (Legal Business Name): BOWLAY REHABILITATION CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 W COMPTON BLVD
COMPTON CA
90220-3008
US

IV. Provider business mailing address

439 W COMPTON BLVD
COMPTON CA
90220-3008
US

V. Phone/Fax

Practice location:
  • Phone: 310-919-5978
  • Fax:
Mailing address:
  • Phone: 310-919-5978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number190791-AP
License Number StateCA

VIII. Authorized Official

Name: CINDY KHAKI
Title or Position: DIR. CLINICAL SERVICES
Credential: CAADAC II
Phone: 323-243-2949