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General NPI Number Information
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NPI Number | 1871877597
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Entity Type | Organization
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Legal Business Name | GOWIN ENTERPRISES INC
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Dates
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Enumeration Date | 09/29/2011
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 300 LERNA RD S
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City | MATTOON
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State | IL
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Zip | 61938-9389
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Country | US
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Telephone | 217-234-3003
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Fax | 217-234-3081
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Provider Business Mailing Address
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Address Line | 6484 N COUNTY ROAD 1320E
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City | CHARLESTON
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State | IL
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Zip | 61920-7952
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Country | US
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Telephone | 217-345-9415
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Fax | 217-345-9415
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. THERESA SUZANNE GOWIN
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Credential |
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Telephone | 217-234-3003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 5103061
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License Number State | IL
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