Provider Demographics
NPI:1962667782
Name:BOW CREEK RECOVERY CENTER
Entity Type:Organization
Organization Name:BOW CREEK RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:DENGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-520-2466
Mailing Address - Street 1:24093 BOW CREEK LANE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607
Mailing Address - Country:US
Mailing Address - Phone:208-459-1883
Mailing Address - Fax:208-455-1392
Practice Address - Street 1:24093 BOW CREEK LN
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-7529
Practice Address - Country:US
Practice Address - Phone:208-459-1883
Practice Address - Fax:208-455-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility