Healthcare Provider Details

I. General information

NPI: 1568734812
Provider Name (Legal Business Name): BOWIE SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W HIGHWAY 287 S
BOWIE TX
76230-3119
US

IV. Provider business mailing address

2071 FLATBUSH AVE SUITE 22
BROOKLYN NY
11234-3523
US

V. Phone/Fax

Practice location:
  • Phone: 718-338-2999
  • Fax:
Mailing address:
  • Phone: 718-338-2999
  • Fax: 718-338-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: ZEVI KOHN
Title or Position: CFO
Credential:
Phone: 718-338-2999