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General NPI Number Information
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NPI Number | 1366584179
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Entity Type | Organization
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Legal Business Name | BOWMAN PLACE
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 3153 WATERVIEW DR SW
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City | SUPPLY
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State | NC
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Zip | 28462-5227
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Country | US
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Telephone | 910-846-2636
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Fax | 910-846-2635
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Provider Business Mailing Address
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Address Line | 3153 WATERVIEW DR SW
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City | SUPPLY
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State | NC
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Zip | 28462-5227
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Country | US
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Telephone | 910-846-2636
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Fax | 910-846-2635
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | LINDA D. REVELS-CARTER
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Credential |
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Telephone | 910-846-2636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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