Provider Demographics
NPI:1659708790
Name:DOWTIN'S THERAPEUTIC HOME
Entity Type:Organization
Organization Name:DOWTIN'S THERAPEUTIC HOME
Other - Org Name:ED EMMANUEL HOMES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHABRITTANY
Authorized Official - Middle Name:ARVON
Authorized Official - Last Name:DOWTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-231-2981
Mailing Address - Street 1:PO BOX 26153
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27611-6153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3912 WILLOW OAK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-4725
Practice Address - Country:US
Practice Address - Phone:919-349-5540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC092369320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities