Provider Demographics
NPI:1720423205
Name:BOWLAY REHABILITATION CENTERS, INC.
Entity Type:Organization
Organization Name:BOWLAY REHABILITATION CENTERS, INC.
Other - Org Name:BOWLAY REHABILITATION CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIR. CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAKI
Authorized Official - Suffix:
Authorized Official - Credentials:CAADAC II
Authorized Official - Phone:323-243-2949
Mailing Address - Street 1:439 W COMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3008
Mailing Address - Country:US
Mailing Address - Phone:310-919-5978
Mailing Address - Fax:
Practice Address - Street 1:439 W COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3008
Practice Address - Country:US
Practice Address - Phone:310-919-5978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190791-AP251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197571OtherCAL-OHMS NUMBER
CA19DAOtherDMC PROVIDER NUMBER 19DA