Healthcare Provider Details

I. General information

NPI: 1154994846
Provider Name (Legal Business Name): GROW HEALTHCARE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 S ALMADEN BLVD STE 600
SAN JOSE CA
95113-1605
US

IV. Provider business mailing address

99 ALMADEN BLVD STE 600
SAN JOSE CA
95113-1605
US

V. Phone/Fax

Practice location:
  • Phone: 408-402-4385
  • Fax: 954-480-1784
Mailing address:
  • Phone: 408-402-4385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RAFID FADUL
Title or Position: OWNER
Credential:
Phone: 201-293-7689