Provider Demographics
NPI:1801915376
Name:GOWAN GROUP CARE
Entity type:Organization
Organization Name:GOWAN GROUP CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:GOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-652-8755
Mailing Address - Street 1:571 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-3516
Mailing Address - Country:US
Mailing Address - Phone:828-652-8755
Mailing Address - Fax:
Practice Address - Street 1:571 E COURT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-3516
Practice Address - Country:US
Practice Address - Phone:828-652-8755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL059021311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805502Medicaid