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General NPI Number Information
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NPI Number | 1538899174
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Entity Type | Organization
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Legal Business Name | BOWS CENTER
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 455 S 48TH ST STE 105
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City | TEMPE
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State | AZ
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Zip | 85281-2302
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Country | US
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Telephone | 480-664-6554
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Fax |
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Provider Business Mailing Address
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Address Line | 455 S 48TH ST STE 105
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City | TEMPE
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State | AZ
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Zip | 85281-2302
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Country | US
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Telephone | 480-664-6554
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GRACE AGNES BEACHAM
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Credential |
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Telephone | 480-664-6554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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