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General NPI Number Information
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NPI Number | 1962667782
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Entity Type | Organization
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Legal Business Name | BOW CREEK RECOVERY CENTER
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 24093 BOW CREEK LN
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City | CALDWELL
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State | ID
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Zip | 83607-7529
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Country | US
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Telephone | 208-459-1883
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Fax | 208-455-1392
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Provider Business Mailing Address
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Address Line | 24093 BOW CREEK LANE
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City | CALDWELL
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State | ID
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Zip | 83607
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Country | US
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Telephone | 208-459-1883
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Fax | 208-455-1392
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. LINDA SUSAN DENGLER
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Credential |
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Telephone | 510-520-2466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | ID
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