Provider Demographics
NPI:1588803068
Name:COMMUNITY DAY PROGRAM, LLC
Entity Type:Organization
Organization Name:COMMUNITY DAY PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:2525-339-6549
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:RICH SQUARE
Mailing Address - State:NC
Mailing Address - Zip Code:27869
Mailing Address - Country:US
Mailing Address - Phone:252-539-6549
Mailing Address - Fax:252-539-6549
Practice Address - Street 1:117 W JACKSON ST.
Practice Address - Street 2:
Practice Address - City:RICH SQUARE
Practice Address - State:NC
Practice Address - Zip Code:27869
Practice Address - Country:US
Practice Address - Phone:252-539-6549
Practice Address - Fax:252-539-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health