Provider Demographics
NPI:1275774556
Name:BOWIE THERAPEUTIC NURSERY CENTER, INC.
Entity Type:Organization
Organization Name:BOWIE THERAPEUTIC NURSERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAUFFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-262-9167
Mailing Address - Street 1:3120 BELAIR DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3101
Mailing Address - Country:US
Mailing Address - Phone:301-262-9167
Mailing Address - Fax:301-805-5094
Practice Address - Street 1:3120 BELAIR DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3101
Practice Address - Country:US
Practice Address - Phone:301-262-9167
Practice Address - Fax:301-805-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21381252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD646410600Medicaid