Provider Demographics
NPI:1003020843
Name:THEA BOWMAN LEADERSHIP ACADEMY
Entity Type:Organization
Organization Name:THEA BOWMAN LEADERSHIP ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ADELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:219-883-4826
Mailing Address - Street 1:975 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-1708
Mailing Address - Country:US
Mailing Address - Phone:219-883-4826
Mailing Address - Fax:219-883-1331
Practice Address - Street 1:975 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-1708
Practice Address - Country:US
Practice Address - Phone:219-883-4826
Practice Address - Fax:219-883-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)