Organization
BOWMAN PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA D. REVELS-CARTER (OWNER/DIRECTOR)
(910) 846-2636
Entity
Organization
Contact information
Practice address
3153 WATERVIEW DR SW, SUPPLY, NC 28462-5227
(910) 846-2636
(910) 846-2635
Mailing address
3153 WATERVIEW DR SW, SUPPLY, NC 28462-5227
(910) 846-2636
(910) 846-2635
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24690477T
—
NC
Enumeration date
02/12/2007
Last updated
06/12/2012
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