Provider Demographics
NPI:1366584179
Name:BOWMAN PLACE
Entity type:Organization
Organization Name:BOWMAN PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:REVELS-CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-846-2636
Mailing Address - Street 1:3153 WATERVIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-5227
Mailing Address - Country:US
Mailing Address - Phone:910-846-2636
Mailing Address - Fax:910-846-2635
Practice Address - Street 1:3153 WATERVIEW DR SW
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-5227
Practice Address - Country:US
Practice Address - Phone:910-846-2636
Practice Address - Fax:910-846-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC24690477TMedicaid