Provider Demographics
NPI:1427169580
Name:BOWIE THERAPEUTIC NURSERY CENTER, INC.
Entity type:Organization
Organization Name:BOWIE THERAPEUTIC NURSERY CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEFEO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:301-262-9167
Mailing Address - Street 1:3120 BELAIR DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3101
Mailing Address - Country:US
Mailing Address - Phone:301-262-9167
Mailing Address - Fax:301-805-5094
Practice Address - Street 1:3120 BELAIR DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3101
Practice Address - Country:US
Practice Address - Phone:301-262-9167
Practice Address - Fax:301-805-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services