Healthcare Provider Details

I. General information

NPI: 1730906603
Provider Name (Legal Business Name): GROW PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 W LOS ANGELES AVE
SHAFTER CA
93263-2523
US

IV. Provider business mailing address

4800 CORPORATE CT
BAKERSFIELD CA
93311-8706
US

V. Phone/Fax

Practice location:
  • Phone: 661-630-7220
  • Fax:
Mailing address:
  • Phone: 661-432-7880
  • Fax: 661-404-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZA DYER
Title or Position: LEAD SCHOOL SOCIAL WORKER
Credential: LCSW
Phone: 661-602-8777