Provider Demographics
NPI:1073053625
Name:BOWDOIN RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:BOWDOIN RECOVERY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-462-7392
Mailing Address - Street 1:431 NISSAN DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4365
Mailing Address - Country:US
Mailing Address - Phone:615-462-7392
Mailing Address - Fax:615-267-0020
Practice Address - Street 1:431 NISSAN DR STE 202
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4365
Practice Address - Country:US
Practice Address - Phone:615-462-7392
Practice Address - Fax:615-267-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000018108101YM0800X, 101YP2500X, 106H00000X, 101YA0400X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ032396Medicaid